CareAdvance Expedited Requests: If an authorization is an expedited request, please wait 30-60 minutes to enter an additional note in the Case Communication or call Medical Intake with the case number to expedite.
Authorizations
- 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 - August 1, 2021Open a PDF
- Medical Prior Authorization Code List - May 1, 2021Open a PDF
- Medical Prior Authorization Code List- February 23, 2021Open a PDF
- Medical Prior Authorization Code List- February 1, 2021Open a PDF
- Medical Prior Authorization Code List- January 1, 2021Open a PDF
- Durable Medical Equipment - August 1, 2021Open a PDF
- DME Prior Authorization List - May 1, 2021Open a PDF
- DME Prior Authorization List - February 23, 2021Open a PDF
- DME Prior Authorization List - February 1, 2021Open 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 - February 1, 2021Open a PDF
- eviCore Codes Requiring Preauthorization - August 1, 2021Open a PDF
- eviCore Codes Requiring Preauthorization - May 1, 2021Open a PDF
- eviCore Codes Requiring Preauthorization - February 1, 2021Open a PDF
- Medical Specialty Drugs Requiring preauthorization (For Commercial, Exchange and Medicare)Open a PDF
New to CareAdvance Provider? | CareAdvance Provider FAQ'sOpen a PDF | Admission Procedures Now AvailableOpen 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 Drugs Requiring preauthorization (For Medicaid, Essential Plan and Child Health Plus)Open a PDF
