Submit Prospect Support Tickets

Submit your Prospect-related claim or authorization request online to skip hold times and get a quicker response through our secure form.

Our hours of operation are from Monday to Friday from 8am to 5pm PST.

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Type of Request *

Claims
Routine Authorizations/Referrals
STAT Authorizations/Referrals
Eligibility

STAT Authorization/Referral – Emergency and life threatening: A referral due to potential morbidity, mortality, or serious condition involved that requires a treatment plan or approval. The turnaround time (TAT) for STAT requests is 72 hours to ensure timely review and response.

Our hours of operation are from Monday to Friday from 8am to 5pm PST. These forms are for STAT only, not for routine, modifications or retros. Please use Aerial Portal for these requests.

Routine Authorization/Referral – New routine authorization will need to be submitted through Aerial Care. The turnaround time (TAT) for routine requests is 5 business days to ensure timely review and response.

Claims – New Claims must be submitted through Office Ally to ensure timely review and processing. Please note that claim status inquiries for dates of service within the past 30–45 business days will not be reviewed, as these claims are still within the standard processing timeframe. If you would like to immediately check your claim status, please use the following link: https://provider-portal.astranahealth.com/prospect-claim-status

Eligibility – Eligibility Online Web Form replaces phone calls for eligibility requests. Urgent requests have a 1-hour TAT; routine requests have a 24-hour TAT.

Claims Category *

For immediate claim status updates, use: https://provider-portal.astranahealth.com/prospect-claim-status

PMS Claim Number (If Known)

Member ID *

Member Name *

First

Last

Date of Birth (MM/DD/YYYY) *

Claim Date of Service (MM/DD/YYYY) *

Total Billed *

Billing Provider TIN *

Billing Provider Name *

Provider Callback Number *

Extension (If Applicable)

Email *

Message

Attachments:

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Authorization Category *

Member Name *

First

Last

Member ID *

Date of Birth (MM/DD/YYYY) *

Referring Provider Name *

First

Last

Requested Provider Name *

First

Last

Specialty *

Date submitted (MM/DD/YYYY) *

Submitted by *

Referral/Authorization Number *

Provider Callback Number *

Extension (If Applicable)

Email *

Message

IPA Name *

Member Name *

First

Last

Authorization Provider

Member ID *

Health Plan Name *

Date of Birth (MM/DD/YYYY) *

Member Phone Number *

Referring Provider Name *

First

Last

Referring Provider Speciality *

Please specify if the referring provider is PCP, or specialist office. If specialist, please include specialty

Requested Provider Name *

First

Last

Specialty *

Date submitted (MM/DD/YYYY) *

Submitted By (Provider Staff Name) *

Place of Service *

CPT Code *

Diagnosis/ICD10 Code *

Provider Callback Number *

Extension (If Applicable)

Email *

Message *

Attachments *

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Member Name *

First

Last

Member ID *

IPA *

Member Health Plan *

Member DOB *

Effective Date *

PCP *

Submitted By:

Phone Number *

Email Address *

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