Use these questions and answers to understand what is changing for individual plans beginning January 1, 2027, and how those changes may affect administrative activities such as Availity access, claims, prior authorization, payments, appeals, and contact information.
What is changing on January 1, 2027?
Starting January 1, 2027, LifeWise will be changing how we administer its Individual plans, which are currently managed by Evolent. This change will affect how providers and members interact with us and manage key administrative activities.
LifeWise uses Availity Essentials for plan administration. Sign in to Availity.
What payer do I use in Availity for individual plan members?
Beginning January 1, 2027, providers will use the same Availity payer for individual members that they already use for non-individual LifeWise members: LifeWise Health Plan of Washington.
Dental providers should use the same payers as medical providers for individual dental plan members.
What if I don’t see LifeWise Health Plan of Washington in the Availity payer drop-down menu?
If you are an active user in Washington or Alaska and do not see LifeWise Health Plan of Washington in the payer drop-down menu for that region and application, contact Availity Client Services at 800-282-4548, 8 a.m. to 8 p.m. ET, Monday through Friday.
What Availity tools will be available for individual plans in 2027?
Beginning January 1, 2027, providers will use Availity for eligibility and benefits, claim submission for professional, facility, and dental claims, claim status, the C3 Claims Editor, remittance viewer including explanation of payments, prior authorization, fee schedules, PCP roster, and electronic funds transfer enrollment and cancellation requests.
Are there changes to member ID numbers or cards?
Yes, Individual plan member ID numbers are changing. Providers must use 2026 ID numbers for 2026 dates of service and 2027 ID numbers for 2027 dates of service. Starting January 1, 2027, providers should ask individual plan members to show their new ID cards.
You should enter 2027 ID card numbers into Availity for 2027 dates of service. Claims cannot be adjusted to reflect the current ID number, so the claim would need to be resubmitted.
Will claim submission change for individual plans?
Yes. Beginning January 1, 2027, providers will continue using the same claim form, but they will submit claims through Availity or mail them to the new claims address. Professional, facility, and dental claims can be submitted in Availity beginning January 1, 2027.
The claims mailing address will change to the same address used for LifeWise commercial plans: PO Box 91059, Seattle, WA 98111-9159.
Can I check claim status and payment details in Availity?
Yes. Beginning January 1, 2027, providers can check claim status, detailed payment information, and explanation of payments in Availity.
Will federal Surprise Billing notifications change?
Yes. Beginning January 1, 2027, federal Surprise Billing notifications will be included with provider explanation of payments under LifeWise’s standard process. Today, providers receive a separate letter explaining their rights when a surprise bill claim appears on an explanation of payment.
Only the notification method will change; how the legislation is applied will stay the same.
Will payment or medical policies continue to apply?
Providers currently use LifeWise payment and medical policies and will continue to use them in 2027.
Additionally, policies addressing routine test management will now apply to individual lines of business starting January 1, 2027.
How will standard fee schedules be made available for individual plans?
Standard fee schedules will be available in Availity, which is new for individual plans.
How will appeals be submitted beginning January 1, 2027?
Beginning January 1, 2027, providers will use the same appeal form used for non-individual plans. Note this form has a different fax number and mailing address than the previous individual plan form.
What happens to prior authorization on January 1, 2027?
Beginning January 1, 2027, new prior authorizations will no longer go through Evolent (Identifi). Providers will submit prior authorizations through Availity or use the standard LifeWise forms available on LifeWise.com.
Will individual plans have a separate prior authorization code list or separate medical policies?
No, there will no longer be a separate prior authorization code list for individual plans. Providers will use the LifeWise code list.
Additionally, individual plans will not have separate or different medical policies for services on the code list. All services will be reviewed using the same medical policy regardless of plan type.
What happens to open prior authorizations during the transition?
Open prior authorizations will transfer to LifeWise systems as of January 1, 2027. All approvals remain subject to member eligibility, plan benefits, and provider network status at the time of service.
How will inpatient admissions and continued stays be handled?
Starting January 1, 2027, LifeWise will review Individual plan admissions and continued stays. Providers should submit planned admission requests to LifeWise beginning on that date.
Evolent will manage all inpatient stays and requests for planned admissions through December 31, 2026. Open authorizations for planned admissions and concurrent reviews for members currently admitted on the transition date will transfer to LifeWise as of January 1, 2027.
Where should I submit prior authorization requests in late December 2026 for services in 2027?
Prior authorization requests made in 2026 should be submitted to Evolent regardless of the date of service. Requests submitted to LifeWise in late December 2026 for services scheduled on or after January 1, 2027, may be rejected, delayed, or require resubmission due to new-year eligibility and benefit availability.
Can I submit retrospective authorization requests to Evolent for dates of service before January 1, 2027?
Yes. When retrospective authorization is needed for dates of service before January 1, 2027, providers can submit requests to Evolent until January 31, 2027.
Will I still use Carelon for some prior authorizations?
Yes, providers will still use Carelon for genetic testing, imaging including CT scan, echocardiography, MRI, MRA, nuclear cardiology, PET scan, radiation oncology, and sleep study and sleep medicine.
Availity will indicate when a service requires prior authorization through Carelon.
What will I use for outpatient rehabilitation?
Beginning January 1, 2027, providers servicing individual plan members will use EviCore for outpatient rehabilitation.
If you need to create an EviCore account, visit the EviCore website.
Availity will indicate when a service requires prior authorization through EviCore.
Are my EFT payments changing?
Yes, InstaMed for EFT will be discontinued for dates of service effective January 1, 2027.
If you are already enrolled for EFT with LifeWise, EFT payments will automatically process. If you are not registered with LifeWise for EFT, visit the LifeWise Get Paid via Electronic Funds & Claims webpage and follow the instructions on the Group plans tab.
After January 1, 2027, providers may continue to receive some EFT payments from InstaMed for dates of service before January 1, 2027.
Will overpayments and refunds change?
Yes, the process for sending refund or overpayment checks will change on January 1, 2027. Refund requests will come from Calypso Overpayment Detection with information on how to submit overpaid amounts. Providers can also use the Overpayment Notification Form to submit a check for the amount overpaid or request that the refund be subtracted from future payments.
Providers should expect some refund or recovery timing delays due to the transition.
Will customer service contact information change?
The customer service phone number, 800-607-0546, will stay the same, but the hours will change to 6 a.m. to 5 p.m. Pacific Time, Monday through Friday.
Where can I find updated contact information?
All contact information providers need will be updated on the Contact Us web page by the January 1 effective date. Most contact information will be changing to what is currently used for non-individual plans.
How can I access historical claims, prior authorizations, appeals, and customer service for earlier plan years?
In 2027, Evolent will continue to support historical claims, prior authorizations, appeals, and customer service for 2020 through 2026 plan years and dates of service before January 1, 2027. Providers will use the payer space INDV Plan-LifeWise Health Plan of Washington or call customer service to check historical information.