Devoted Health

• DH
• Medicare Advantage

Devoted Health

Devoted Health is a tech-enabled Medicare Advantage startup in ~15 states. Provider guide for behavioral health credentialing, prior auth, and billing.

Quick Reference

Payer Type

Medicare Advantage

Parent Company

Devoted Health, Inc. (private, VC-backed)

Headquarters

Waltham, MA

Provider Portal

Open Portal

Portal Guide

View Guide →

Credentialing

CAQH ProView (primary) with Devoted Health provider enrollment application via Devoted Provider Hub

Timeline

60-90 days from completed application; contact Devoted Health provider relations for current queue

Coverage

15 states

Last Verified

Apr 19, 2026

Published

Apr 19, 2026

Reading Time

10 min

Covered Levels of Care

• Inpatient Psychiatric Hospitalization
• Partial Hospitalization Program (PHP)
• Intensive Outpatient Program (IOP)
• Outpatient Mental Health and SUD Treatment
• Medication-Assisted Treatment (MAT)

Medical Necessity Criteria

• CMS Medicare Advantage medical necessity standards
• ASAM Criteria (for SUD level of care placement)
• Devoted Health proprietary clinical review guidelines

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Overview

Devoted Health is a technology-enabled Medicare Advantage organization founded in 2017 and headquartered in Waltham, Massachusetts. The company was built from the ground up by former executives from health-tech, health plan, and technology companies with the goal of creating a Medicare Advantage plan that uses modern software infrastructure to improve the member experience and care coordination. Devoted operates as a private company backed by venture capital and has grown from its initial launch in Florida in 2018 to approximately 15 states as of 2025, making it one of the more rapidly expanding Medicare Advantage entrants in recent years.

For behavioral health providers, Devoted Health behaves operationally as a Medicare Advantage plan with a tech-forward orientation. Its Devoted Provider Hub at provider.devoted.com ↗ is the primary interface for eligibility inquiries, authorization requests, claims submissions, and clinical communications — a purpose-built portal rather than a reliance on legacy clearinghouse-only connectivity. As with all Medicare Advantage plans, Devoted follows CMS coverage requirements, applies the five-level CMS appeals framework, and adheres to federal timely-filing rules for non-contracted claims.

Devoted’s member population is composed entirely of Medicare beneficiaries — adults age 65 and older, or younger adults who qualify for Medicare on the basis of disability — and as such differs significantly from commercial payer populations. Behavioral health conditions in this demographic frequently present alongside multiple chronic medical conditions, creating higher care complexity and greater importance for care coordination between behavioral health and primary care. Devoted’s model explicitly addresses this through care navigation and care team coordination features.

Behavioral Health Coverage

Devoted Health covers behavioral health services in accordance with CMS Medicare Advantage requirements, with plan-specific enhancements that may vary by plan year and geographic market. Core covered behavioral health services include:

Key coverage limitation: Devoted Health, as a Medicare Advantage plan, does not cover freestanding residential substance use disorder treatment under the standard Medicare benefit. This reflects the underlying Medicare coverage rule — Original Medicare does not cover residential SUD programs, and Medicare Advantage plans must cover at minimum what Original Medicare covers. Some Devoted plan products may include supplemental benefits that enhance behavioral health coverage beyond the Medicare floor; verify current benefit enhancements for the specific plan year and service area with Devoted provider relations.

190-day lifetime limit: Inpatient psychiatric services in freestanding psychiatric hospitals (IPFs) are subject to Medicare’s 190-day lifetime limit per Section 1812 of the Social Security Act. This applies to Devoted Health as a Medicare Advantage plan. Stays in acute care hospital psychiatric units (distinct-part units within general hospitals) are not subject to this cap.

Medical necessity for behavioral health services is assessed against CMS Medicare Advantage standards and Devoted’s own clinical review guidelines. For SUD admissions, ASAM Criteria dimensions are the expected framework for clinical documentation. Active, goal-directed treatment planning is required for continued authorization at all levels of care.

Federal mental health parity requirements (MHPAEA) apply to Medicare Advantage plans. Devoted Health must ensure that behavioral health benefits are not subject to more restrictive non-quantitative treatment limitations than those applied to medical and surgical benefits.

• Inpatient psychiatric hospitalization — in Medicare-certified acute psychiatric units and inpatient psychiatric facilities (IPFs), subject to the CMS 190-day lifetime limit for freestanding IPFs
• Partial hospitalization programs (PHP) — covered as a Medicare Part B–equivalent benefit for active psychiatric and SUD treatment in a structured day program
• Intensive outpatient programs (IOP) — covered as a distinct Medicare Part B benefit beginning 2024 under CMS rules recognizing IOP as a benefit level
• Outpatient mental health and substance use disorder treatment — individual and group psychotherapy, psychiatric evaluation and management, psychological testing, and behavioral health integration services
• Medication-assisted treatment (MAT) — buprenorphine and naltrexone through Part D pharmacy benefit or Part B office-based treatment; methadone through the OTP bundled payment for SAMHSA-certified and Medicare-enrolled opioid treatment programs

Credentialing and Provider Enrollment

Devoted Health uses CAQH ProView as the primary credentialing data source. Providers seeking to join Devoted’s network should maintain a fully attested, current CAQH ProView profile before initiating enrollment. The credentialing process and provider enrollment application are managed through the Devoted Provider Hub at provider.devoted.com ↗.

The typical credentialing timeline is approximately 60 to 90 days from submission of a complete application, though timelines can vary based on network volume and completeness of the application. Contact Devoted Health provider relations to confirm current network availability in your service area and specialty before investing time in the application.

CMS Medicare enrollment prerequisite: Because Devoted is a Medicare Advantage plan, all credentialed providers must be enrolled in Original Medicare through PECOS. This is a CMS requirement that applies to all MA plans. Providers who have not yet enrolled in Medicare through PECOS must do so concurrently with or prior to the Devoted credentialing process. See the Medicare FFS guide for PECOS enrollment instructions.

Facility credentialing with Devoted typically requires:

Recredentialing generally occurs on a three-year cycle consistent with NCQA and CMS standards. Maintain continuous CAQH attestation to avoid credentialing gaps.

• Current state behavioral health facility license
• Accreditation documentation (Joint Commission, CARF, or state-approved equivalent)
• Medicare certification or PECOS enrollment
• Organizational NPI and Tax ID / W-9
• Professional liability insurance at required coverage levels
• Program description with levels of care, staffing ratios, clinical protocols, and outcomes measurement practices

Verification of Benefits (VOB)

Benefits verification for Devoted Health members should be conducted through the Devoted Provider Hub at provider.devoted.com ↗ or via standard HIPAA 270/271 electronic eligibility transactions through your clearinghouse. Devoted is registered with major clearinghouses for electronic eligibility transactions.

Key elements to verify for Devoted members:

Run VOB through the Provider Hub rather than relying on verbal verification alone. Document verification date, the specific benefits confirmed, and any reference number returned.

• Active enrollment in a Devoted Health Medicare Advantage plan (plan year, product, effective dates)
• Behavioral health benefits — covered levels of care, visit or day limits, and whether Devoted manages behavioral health in-house or through a carve-out
• Dual-eligibility status — confirm whether the member is also enrolled in a state Medicaid program. Dual-eligible members may have state Medicaid as a secondary payer for cost-sharing or for services not covered by the MA plan
• Prior authorization requirements by level of care
• Deductible and cost-sharing applicable to the member’s specific plan product
• In-network vs. out-of-network benefit — Devoted’s plans may have HMO or PPO structures with different out-of-network provisions

Prior Authorization Requirements

Devoted Health requires prior authorization for most behavioral health services beyond standard outpatient mental health therapy. As a Medicare Advantage plan, Devoted follows CMS prior authorization rules, which include transparency and standardization requirements that have been progressively tightened since 2023.

Services typically requiring prior authorization with Devoted Health:

Services that may not require authorization:

Submit authorization requests through the Devoted Provider Hub. Clinical documentation should be framed around CMS Medicare Advantage medical necessity standards and, for SUD admissions, ASAM Criteria. Include diagnosis, presenting symptoms and history, current functional status, rationale for the requested LOC, and documentation that less intensive levels of care would be clinically insufficient.

CMS-mandated authorization decision timelines that apply to Devoted Health:

Concurrent review is required for inpatient and PHP authorizations. Review frequency is typically every 3 to 7 days at the inpatient level and weekly for PHP. Provide updated clinical documentation at each concurrent review demonstrating ongoing medical necessity, treatment progress, and active discharge planning.

Request a peer-to-peer review with a Devoted medical director when an initial or concurrent-stay authorization is denied. Document all peer-to-peer conversations including date, participants, and outcome.

• Inpatient psychiatric hospitalization (prior to admission or notification within required timeframe for emergency admissions)
• Partial hospitalization programs (PHP)
• Intensive outpatient programs (IOP)
• Opioid treatment program (OTP) enrollment and bundled services
• Medically managed or monitored detoxification

• Standard outpatient psychotherapy and psychiatric medication management (verify by plan product and service area)

• Standard requests: determination within 14 calendar days
• Expedited / urgent requests: determination within 72 hours
• Inpatient concurrent review requests: determination within 24 hours (for urgent concurrent reviews)

Claims and Billing

Devoted Health is a Medicare Advantage plan with its own payer ID. Do not route Devoted Health claims to your Medicare Administrative Contractor (MAC) — claims must go to Devoted Health directly via its designated payer ID and clearinghouse routing. Using the wrong payer will result in a routing rejection that consumes timely filing time.

Claim formats:

Timely filing:

Timely filing denial is one of the most avoidable denial types. Track submission dates carefully, submit promptly, and retain clearinghouse confirmation reports as proof of timely filing in case of disputes.

Common denial reasons for Devoted Health behavioral health claims:

CMS Five-Level Medicare Appeals Process

Because Devoted is a Medicare Advantage plan, all coverage and payment denials are subject to the CMS five-level Medicare Advantage appeals framework:

Each appeal level has strictly enforced filing deadlines. A missed deadline without good cause generally forfeits appeal rights at that level and all higher levels. Submit appeals through the Devoted Provider Hub with complete clinical documentation addressing the specific denial reason.

• Institutional claims (inpatient psychiatric, PHP, IOP billed institutionally, OTP): UB-04 / 837I
• Professional claims (outpatient psychotherapy, medication management): CMS-1500 / 837P

• Contracted providers: per the Devoted provider agreement — typically 90 days from date of service (verify in your specific contract)
• Non-contracted providers: 1 calendar year from the date of service, per CMS Medicare Advantage rules (42 CFR 422.520)

• Claim submitted to Medicare FFS MAC instead of Devoted Health (routing error)
• Missing prior authorization or authorization number not included on claim
• Diagnosis code not matching the authorized service
• Revenue code or CPT code inconsistent with the authorized level of care
• Provider not credentialed with Devoted Health or Medicare enrollment lapsed
• Service rendered outside the member’s Devoted plan service area
• Timely filing exceeded

• Redetermination by Devoted Health — must be filed within 60 days of the initial denial; standard decision within 60 days, expedited within 72 hours
• Reconsideration by a CMS-contracted Qualified Independent Contractor (QIC) — must be filed within 180 days of the Redetermination decision; standard decision within 60 days, expedited within 72 hours
• Administrative Law Judge (ALJ) hearing before the HHS Office of Medicare Hearings and Appeals (OMHA) — must meet the minimum amount-in-controversy threshold ($180 in 2025, adjusted annually); file within 60 days of QIC decision
• Medicare Appeals Council (MAC) review — discretionary review by the Departmental Appeals Board; file within 60 days of ALJ decision
• Federal district court — judicial review when federal threshold is met; file within 60 days of MAC decision

Key Contact Information

• Devoted Provider Hub (primary portal): provider.devoted.com ↗
• Credentialing: CAQH ProView + Devoted provider enrollment via the Devoted Provider Hub; contact Devoted provider relations for credentialing status and network availability
• Prior Authorization: Submit through the Devoted Provider Hub; contact Devoted utilization management for urgent or expedited requests
• Verification of Benefits: Devoted Provider Hub or EDI 270/271 via clearinghouse
• Claims Submission: Electronic via clearinghouse using the Devoted Health payer ID (confirm current payer ID with your clearinghouse or via the Devoted Provider Hub)
• Appeals: Five-level CMS MA appeals process; submit through Devoted Provider Hub or per instructions on denial notices
• Medicare PECOS Enrollment (prerequisite): pecos.cms.hhs.gov ↗
• Devoted Health Headquarters: Waltham, MA

Frequently Asked Questions

Devoted Health, founded in 2017, is a technology-focused Medicare Advantage startup that built its care and claims infrastructure from the ground up rather than adapting legacy systems. The company's model emphasizes technology-enabled care navigation, a proprietary provider portal called the Devoted Provider Hub (provider.devoted.com), and a concierge-style member experience. For providers, the most notable operational difference is the Devoted Provider Hub — a purpose-built portal that handles eligibility inquiries, prior authorization submissions, claims status, and clinical communication in a more modern interface than traditional EDI-only payer portals. Devoted has expanded rapidly since its 2018 launch, growing from Florida to approximately 15 states by 2025. As a Medicare Advantage plan, Devoted follows all CMS regulatory requirements including the five-level appeals process and federal timely-filing rules.

As of 2025, Devoted Health operates in approximately 15 states including Florida, Texas, Ohio, Arizona, Pennsylvania, Illinois, Colorado, Georgia, Tennessee, North Carolina, Virginia, South Carolina, Nevada, New Mexico, and Kentucky. Devoted has expanded its geographic footprint each year since launch. Because state availability changes with each Medicare Annual Election Period, providers should verify current state-level plan availability directly at provider.devoted.com or with Devoted provider relations. Credentialing acceptance and network openings vary by service area.

The Devoted Provider Hub (provider.devoted.com) is Devoted Health's purpose-built provider portal. It supports real-time eligibility and benefit inquiries, prior authorization submission and tracking, claims submission and status checking, clinical communication, and member roster management. Unlike some Medicare Advantage plans that rely exclusively on Availity for provider transactions, Devoted has invested in its own portal as the primary provider-facing interface. Registered providers log in with their NPI and Tax ID. Contact Devoted provider relations to register and to receive training on the Hub's features. While Devoted also accepts standard EDI transactions through clearinghouses, the Provider Hub is the recommended channel for authorization requests and eligibility inquiries.

For contracted (in-network) Devoted Health providers, the timely filing deadline is set by the provider agreement — typically 90 days from the date of service for most contracted arrangements, though this may vary by contract. For non-contracted providers, CMS rules apply: Medicare Advantage plans must accept claims for up to one calendar year from the date of service for non-contracted providers. Missing the timely filing deadline results in automatic claim denial with very limited appeal rights. Submit claims as promptly as possible after each date of service, and maintain documentation of submission dates in case timely filing is disputed. Confirm your specific contracted timely filing window in your Devoted Health provider agreement.

Like all Medicare Advantage plans, Devoted Health follows CMS Medicare benefit rules as the floor for coverage. Original Medicare does not cover freestanding residential substance use disorder treatment, and Devoted Health's Medicare Advantage plans therefore generally do not cover this level of care under the standard Medicare benefit. Devoted, like some other MA plans, may offer supplemental benefits that go beyond Original Medicare in select plan products — verify current Devoted benefit enhancements with Devoted provider relations or at provider.devoted.com. For dual-eligible members, state Medicaid may provide coverage for residential SUD treatment through the member's state Medicaid program (separate from the Devoted MA benefit). Inpatient psychiatric hospitalization in a Medicare-certified facility is covered, subject to the 190-day lifetime limit for freestanding psychiatric hospitals.

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This guide is provided for informational purposes only and does not constitute legal, regulatory, or professional advice. Payer requirements, phone numbers, and portal URLs are subject to change. Always verify current information directly with the payer. is not affiliated with the insurance companies described on this page.

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Official sources

• pecos.cms.hhs.govpecos.cms.hhs.gov