Individual Plans Join Your LifeWise Workflow in 2027

A simpler experience is on the way for LifeWise Health Plan of Washington individual plans. Effective January 1, 2027, LifeWise will change how we administer individual plans that are currently managed by Evolent. This change creates a more consistent experience for you across our products.

You’ll use the same Availity Essentials payer space, administrative processes, and support resources you use today for other LifeWise members. While this change is designed to improve your experience, it will affect how you work with individual plans, including how you receive payment, submit or check claims, request prior authorization, and complete other tasks.

Here’s what you need to know about the individual plan transition starting January 1, 2027.

Use the LifeWise Availity Essentials Payer Space

You’ll use the LifeWise Health Plan of Washington payer space in Availity Essentials for individual plan members. This is the same payer space providers use for non-individual members.

If you’re an active Availity Essentials user in Washington and don’t see LifeWise Health Plan of Washington for the right region and application, call Availity Client Services at 800-282-4548. Support is available from 8 a.m. to 8 p.m. Eastern Time, Monday through Friday.

Evolent will continue to support historical individual plan information for 2020 through 2026 dates of service in 2027, including claims, prior authorizations, appeals, and customer service. To find historical information, use the LifeWise Health Plan of Washington payer space and contact Evolent customer service.

Complete More Tasks in Availity Essentials

• Check eligibility and benefits.
• Submit claims and check claim status.
• View remittance and payment details.
• Request prior authorization.
• Enroll in or cancel electronic funds transfer.
• View standard fee schedules, which will be new for individual plans.

Submit Claims and View Payments

• Continue using your current claim submission process, including clearinghouses, Availity Essentials, or paper claims.
• Paper claims should be mailed to the same address used for other LifeWise plans.
• Continue using the same claim form.
• Use Availity Essentials to check claim status, view payment details, and access explanations of payment (EOPs).
• Look for Federal Surprise Billing notices with provider EOPs instead of in a separate letter.
• Reference our current LifeWise payment policies.

Request Prior Authorization

You’ll submit new prior authorization requests through Availity Essentials. New prior authorizations will no longer go through Identifi. You may also use standard LifeWise forms available on lifewise.com.

Keep these transition details in mind:

• Open prior authorizations will move to LifeWise systems on January 1, 2027.
• Approvals remain subject to the member’s eligibility, plan benefits, and provider network status at the time of service.
• Requests submitted in late December 2026 for services on or after January 1, 2027, may be rejected, delayed, or require resubmission because of new-year eligibility and benefit availability.
• Use the LifeWise prior authorization code list for individual plans. A separate individual plan code list will no longer apply.
• LifeWise will use the same medical policies for all plan types. Individual plans will no longer have separate medical policies for services on the code list.

Manage Inpatient and Continued Stays

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.

LifeWise will review individual plan admissions and continued stays starting January 1, 2027.

Using Prior Authorization Vendors

You’ll continue using Carelon Medical Benefits Management (Carelon) for genetic testing, imaging, radiation oncology, and sleep study and sleep medicine prior authorizations. Imaging includes CT scan, echocardiography, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), nuclear cardiology, and positron emission tomography (PET) scan.

Beginning January 1, 2027, providers serving individual plan members will use EviCore for outpatient rehabilitation and follow instructions on the outpatient rehabilitation web page.

Availity Essentials will direct you to Carelon or EviCore when a service requires prior authorization through one of those vendors.

Retrospective Authorizations

For dates of service before January 1, 2027, you may submit retrospective authorization and retrospective medical necessity requests to Evolent until January 31, 2027.

Appeals

Beginning January 1, 2027, you’ll use the same appeal form used for non-individual plans. The fax number and mailing address differ from those on the current individual plan form.

Prepare For Payment Changes

InstaMed electronic funds transfer (EFT) will end for dates of service on or after January 1, 2027.

• If you’re enrolled in EFT with LifeWise, no action is needed. Payments will automatically move to the LifeWise system.
• You may still receive InstaMed payments after January 1, 2027, for earlier dates of service.
• If you’re not enrolled with LifeWise, follow the instructions on the electronic funds transfer overview web page.

The refund and overpayment process will also change:

• Calypso overpayment detection will send refund requests and submission instructions.
• Some refund or recovery activity may be delayed during the transition.
• Use the overpayment notification form and select whether to submit a check, request a voucher deduction or offset, or ask LifeWise to subtract the refund from future payments.

A small number of providers whose contracts are tied to Centers for Medicare & Medicaid Services (CMS) pricing may see changes to their reimbursement amounts due to system updates that more closely align our processes with CMS pricing methodology. The impact will vary based on the services billed and the pricing applied. Providers affected by these changes will receive a letter with more information.

Check Member ID Numbers

Individual plan member ID numbers will change for 2027. Make sure you’re using 2026 ID numbers for 2026 dates of service and 2027 ID numbers for 2027 dates of service.

Starting January 1, 2027, ask members for their new ID cards and enter the 2027 ID number in Availity Essentials. You can’t adjust a submitted claim to use a different ID number. You must resubmit the claim.

Contact Us

The customer service number will remain 800-607-0546. Customer service hours will be extended to 6 a.m. to 5 p.m. Pacific Time, Monday through Friday.

The claims mailing address will change to the same address used for other LifeWise plans:

LifeWise Health Plan of Washington

PO Box 91059

Seattle, WA 98111-9159

The contact us web page will include updated information by January 1, 2027.

Your Next Steps

Tell your staff about the changes and provide training before January 1, 2027:

• Review the individual plan administration transition provider FAQ.
• Confirm that you can select LifeWise Health Plan of Washington for the right region and application in Availity Essentials. If you can’t, call Availity Client Services at 800-282-4548.
• Follow the instructions on the electronic funds transfer overview page, if you aren’t enrolled for EFT with LifeWise.
• Update your internal systems, workflows, and reference materials to reflect the 2027 changes, including new member ID numbers, Availity Essentials processes, forms, mailing addresses, and vendor guidance.
• Add reminders about the 2027 changes to the tools your staff uses.