IMPORTANT UPDATE: We are in receipt of NYS Dept of Financial Services Insurance Circular Letter 17Open a PDF issued December 23, 2020 and will follow the provisions of the state guidance as it applies to our health plan. Please refer to our communication for additional details.
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 have any questions, please contact your Provider Relations Representative.
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 - May 1, 2021Open a PDF
- Medical Prior Authorization Code List- February 1, 2021Open a PDF
- Medical Prior Authorization Code List- January 1, 2021Open a PDF
- Medical Prior Authorization Code List- November 1, 2020Open a PDF
- DME Prior Authorization List - May 1, 2021Open a PDF
- DME Prior Authorization List - February 1, 2021Open a PDF
- DME Prior Authorization List - October 15, 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 - February 1, 2021Open a PDF
- eviCore Codes Requiring Preauthorization - May 1, 2021Open a PDF
- eviCore Codes Requiring Preauthorization - February 1, 2021Open a PDF
- eviCore Codes Requiring Preauthorization - November 1, 2020Open a PDF
- Medical Specialty Drug (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 Drug (For Medicaid, Safety Net, and Essential Plan)Open a PDF
