Personify Health prior authorization: how MedCom reviews a request

Personify Health prior authorization runs through MedCom, Personify’s care program. MedCom’s utilization review nurses check whether a requested service is medically necessary, and the employer’s plan decides which services need that review.

Requests go in through the myCareHC portal or on MedCom’s precertification form. When MedCom denies one, a doctor who wasn’t part of the first review decides the appeal.

At a glance

• MedCom runs medical necessity review for Personify Health plans.
• Each employer’s plan sets which services require prior authorization.
• Submit through the myCareHC portal or MedCom’s fax and secure email.
• Precertification checks medical necessity only and does not guarantee payment.
• MedCom answers appeals within 30 days, or 72 hours if urgent.

Who reviews Personify Health requests

Personify Health is the brand Virgin Pulse and HealthComp unveiled for their combined company on February 7, 2024, and its services include health plan administration. On its plans, MedCom, Personify’s care program, runs utilization review. Its nurses check that a requested service is medically necessary for the member.

MedCom’s precertification form says the employer group’s plan holds the provisions that require review. Which services need prior authorization therefore depends on the employer, so two patients with Personify Health cards can face different rules.

A Personify Health card doesn’t always mean MedCom reviews the request. On South Carolina’s State Health Plan, Personify Health is a free digital wellness program for primary members, and questions about it go to BlueCross, according to South Carolina PEBA. Check what the patient’s card covers before you send a request.

Submitting through the myCareHC portal

MedCom publishes these steps on its Providers page:

1. Sign up or log in at myCarehc.com/provider.
2. Select Utilization Review, then enter the member’s SSN or member ID along with the group number.
3. Enter the CPT or HCPCS codes for the requested service.
4. Attach all relevant clinical documentation and submit the request.

MedCom sends an email when the review is complete, and you can check the status in the portal at any time.

The MedCom precertification form

For a request sent by fax or email, the Personify Health prior authorization form is MedCom’s Precertification Request Form (revised 09/2025). Send it with the supporting clinical documentation by fax to 559-243-7012 or 985-898-1505, or by secure email to UMFax@personifyhealth.com, according to the form itself.

Questions about a request go to the customer service number on the back of the member’s ID card. The form also says precertification reviews medical necessity only and doesn’t guarantee payment or confirm coverage.

Silna faxes or uploads every MedCom request for your team

How long a decision takes

Each plan sets its own decision times. Mountain Health Co-op, whose form sends requests to the same UMFax@personifyhealth.com address, publishes these, according to its December 2024 form:

Both windows start once all required documentation is received. For another plan, check the plan’s own documents or call the number on the ID card.

How a MedCom appeal works

The member, their doctor, someone the member chooses or the care provider can appeal a MedCom medical necessity denial, according to MedCom’s appeals page. Include the case number from the first review and the records that show the service is needed.

A doctor who wasn’t part of the first review decides the appeal, and MedCom publishes two reply times.

30 days

reply to a standard appeal

72 hrs

reply to an urgent appeal

If the denial stands, a doctor outside MedCom gives the final review. Silna’s guide to appealing a prior authorization denial covers the general steps.

How Silna works with Personify Health plans

Silna checks each patient’s plan requirements before a request goes to MedCom. It submits the request with the documents it needs and follows up until a decision comes back. G2 reviewers rate it 4.8 out of 5 across 66 verified reviews.

Key terms

Utilization review

A check of whether a requested service, hospital stay or supply is needed, made against the plan's benefits and the patient's records.

Medical necessity

The standard a reviewer applies to decide whether a service meets normal standards of medicine for the patient.

Precertification

A medical necessity review of a planned service before it happens, also called prior authorization.

myCareHC

The provider portal where staff submit MedCom requests and check their status.

Frequently Asked Questions

What is the Personify Health fax number?

Fax the MedCom Precertification Request Form to 559-243-7012 or 985-898-1505, or email it to UMFax@personifyhealth.com. Attach the clinical documentation.

Does a Personify Health approval guarantee payment?

No. MedCom’s form calls precertification a medical necessity review only, so payment still depends on the plan’s eligibility rules and benefits.

Who can appeal a Personify Health denial?

The member, their doctor, the care provider or someone the member chooses. MedCom sends each appeal to a separate review group.

Is a Personify Health card always a medical plan?

Not always. On South Carolina’s State Health Plan, for example, Personify Health is a wellness program, and BlueCross answers questions about it.

This article is general educational information and does not give medical, legal or insurance advice. Each employer’s plan sets its own review rules, so confirm them for each patient before you rely on this guide.

About the author

Jeffrey Morelli

Jeffrey Morelli is the Co-Founder and CEO of Silna Health, the first Care Readiness Platform built to remove the administrative barriers that delay care. Silna automates benefit checks, eligibility, and prior authorizations across 1,000+ payors, and is backed by $27M from Accel and Bain Capital Ventures. Before Silna, Jeff spent a decade in San Francisco building and scaling products for highly regulated industries, including leading go-to-market at Truework (Series C, acquired by Checkr).

Last updated: November 3, 2026.