Important Information and resources for Stanford Health Care Alliance network providers
Provider Operations Guide
Information specific to SHC Alliance Medical Home Model plans for the following employers:
SHCA enrollees in these plans have a designated Primary Care Physician (PCP) and most visits to a specialist will require a referral from their PCP.
- Referral Info and FAQs – important information and frequently asked questions on specialty referral process and requirement
- Direct Access – this is a list of services that do not require a PCP referral
- Specialty Taxonomy Code List – reference document for all specialties
- Availity Referral Submission Guide - Reference guide on how to submit a referral in Availity (non-EPIC users)
- Availity FAQs and Training
eviCore Prior Authorization Resources
(applicable to Stanford University Faculty & Staff SHCA enrollees only)
The eviCore Prior Authorization CPT Code List includes services that require submission to eviCore for advanced clinical review and authorization prior to services being rendered, including advanced (high-cost) imaging, cardiology imaging, interventional pain management, large joint services, and sleep diagnostic services.
Please note that radiation therapy (e.g., radiation oncology) prior authorizations services do not require eviCore prior authorization
Aetna National Precertification List
The SHC Alliance plans for Cisco and Stanford utilize the Aetna National Precertification List (“Aetna NPL”). The current Aetna NPL can be located at the following link, and is routinely updated on a quarterly basis:
Providers can submit authorizations for Stanford or Cisco members to SHC Alliance through the Aetna Provider Portal or by calling Aetna Provider Services
For additional information, please contact the Stanford Health Care Alliance Network team.