We are aware of issues with CareAdvance Provider being slow and timing out and we are working to resolve the issue.
Please continue to enter authorizations through the system.
They are being saved and processed internally, although you may not see the result due to the system delays.
Authorizations entered today will be available for review tomorrow.
We apologize for any inconvenience at this time; we are working on making your experience better.
Learn how to use our new CareAdvance tool with training materials located on our website under Resources > Staff Training > Presentations & Guidebooks. For additional information view FAQ's Open a PDF.
If you receive an error message stating "You have no associated provider sets", we can help you; please email your Web Username and Individual or Group NPI to CAPAdministratorUnivera@univerahealthcare.com to update the system.If you have any questions, please contact your Provider Relations Representative.
- Please review the eMedNY website for benefit coverage of specific codes prior to submitting a preauthorization request for MMC or HARP members.
The medical services including provider administered drugs below require prior review by the plan to determine clinical medical necessity.
Referral & Authorization Guidelines
- Medical Prior Authorization Code List - October 15, 2020Open a PDF
- Medical Prior Authorization Code List - August 1, 2020Open a PDF
- DME Prior Authorization List - October 15, 2020Open a PDF
- DME Prior Authorization List - August 1, 2020Open a PDF
- UM Initial Determination Timeframes - Commercial ProductsOpen a PDF
- UM Initial Determination Timeframes - Medicare ProductsOpen a PDF
- UM Initial Determination Timeframes - Medicaid & Safety Net ProductsOpen a PDF
- Behavioral Health Prior Authorization List - October 1, 2020Open a PDF
- eviCore Codes Requiring Preauthorization - November 1, 2020Open a PDF
- eviCore Codes Requiring Preauthorization - November 27, 2019Open a PDF
- Medical Specialty Drug (For Commercial, Exchange, and Medicare)Open a PDF
Univera Healthcare MyHealthSM, Child Health Plus and MyHealth PlusSM
- Inpatient Prior Authorization FormOpen a PDF
- Outpatient Prior Authorization FormOpen a PDF
- Adult Behavioral Health Home and Community Based Services Prior/Continuing Authorization FormOpen a PDF
- Behavioral Health Outpatient Treatment Request FormOpen a PDF
- Inpatient and Outpatient Neuropsychological and Psychological Testing Authorization FormOpen a PDF
- Behavioral Health Prior Authorization Guidelines Code List Effective July 1, 2019Open a PDF
- Medical Specialty Drug (For Medicaid, Safety Net, and Essential Plan)Open a PDF