See … As an Aetna Better Health of New York provider, you may need to prescribe a necessary therapy for a member. In this section you will find the tools and resources you need to help manage your practice’s prior authorization and notification requirements, with program specific information available for Cardiology, Oncology, Radiology, Clinical Pharmacy and Specialty Drugs For assistance: Contact the Provider Call Center at 1-888-FIDELIS (1-888-343-3547) All Prior Authorizations can be submitted online, except the following: Must be submitted via the appropriate fax line or by phone at 1-888-FIDELIS (1-888-343-3547): • Urgent Requests. Submit online at National Imaging Associates or call 1-800-642-7820. First Name: 4. Enrolled Practitioners SEARCH (including OPRA), National Diabetes Prevention Program (NDPP), Edit/Error Knowledge Base (EEKB) Search Tool. Information about eligibility and prior authorization can be found at eviCore healthcare. Sign up to receive e-mail notifications on changes to NYS Medicaid Pharmacy Programs. Overview of Referrals and Prior Authorizations, HCP Preferred Specialist Network and Centers of Excellence, PCP Services NOT Requiring Prior Authorization, Specialty Care Services NOT Requiring Prior Authorization – PSN Specialists, Prior Authorization – Hospital & Facility Based Services, Prior Authorization – Preventive Care Services, Prior Authorization – Injectable Medications, Prior Authorization – Lab and Pathology Services, Prior Authorization – Physical and Occupational Therapy, Prior Authorization – Cohort 2 Utilization Management Programs, View an existing Prior Authorization Request. NYS Medicaid FFS is providing this form for use with the Advanced Imaging Ordering Program. Please refer to UnitedHealthcare’s Physician, Health Advanced Imaging Ordering Program Procedure Request Form. All Rights Reserved. Before rendering the service, the radiologist must verify that prior authorization was obtained. MetroPlus Health Plan is active in maintaining a library of resources to assist our participating providers treat their patients. Mammography. View and download a printable copy of HCP’s Authorization Request form here. Through a partnership with the two leading freestanding imaging organizations in NYC and LI, Zwanger-Pesiri and RadNet, which together comprise a large network of outpatient imaging centers that can bring real-time diagnostics to the busy Primary Care Practitioner. Use the Prior Authorization tool within Availity or Call Provider Services at 1-800-450-8753 (TTY 711) After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-300-8181 Authorization can be requested through our Connect portal. Prior Authorization & Exception Forms General Authorization Form (exclusion may apply to some plans) (PDF) Some of these services require prior authorization. In keeping with DFS guidance, MetroPlus's UM protocols will resume on June 22, 2020. Our broad specialist network accounts for all non-hospital-based specialties defined by nationally recognized Boards of Accreditation. Effective May 14, 2020, the fee-for-service (FFS) pharmacy program implemented the following parameters: Providers must be enrolled in New York State Medicaid Fee for Service. Check Prior Authorization Status As part of our continued effort to provide a high quality user experience while also ensuring the integrity of the information of those that we service is protected, we will be implementing changes to evicore.com in the near future. to 3:00p.m. The Molina Healthcare Drug Formulary is a listing of preferred drug products eligible for reimbursement by Molina Healthcare. How to obtain service prior authorization. Medicaid Pharmacy Prior Authorization Programs Update. For Emblem Health Cohort 2 patients (with no direct HCP contract), you must contact eviCore for high-tech imaging and cardiac imaging requests. Medicare Part D Medications. Authorization Agreement for Preauthorized Payments form (SF-5510), and indicate the type of change you want to make on the form. Please complete all fields on the form unless otherwise noted. Prior Authorization Request Form (NY) (Submit Online) Prior Authorization Request Form for DME/O&P Items and Services (NY) (Submit Online) Radiology and Radiation Therapy. If you are ordering a CT, CTA, MRI, MRA, Cardiac Nuclear, or PET procedure, If you also provide in-office radiology imaging, you are asked to confirm that, Using a secure login, you will have the ability to access. A request for Prior Authorization can be submitted to HCP in one of two ways: Login credentials for EZ-Net are required. Radiology Notification and Prior Authorization Fax Request Form This FAX form has been developed to streamline the Notification and Prior Authorization request process, and to give you a response as quickly as possible. OHP has coverage criteria for several studies defined throughout the Prioritized List (PL), including lumbar spine MRI defined in Diagnostic Guidelines D4. Last Name: 3. For a full list of services that require prior authorization, see your member policy. Whether submitting imaging exam requests or checking the status of ordered exams, providers will find RadMD to be an efficient, easy-to-navigate resource. All medications are listed by generic name. If you are performing a CT, CTA, MRI, MRA, Cardiac Nuclear, or PET procedure, you must verify that an approval has been obtained before performing these diagnostic imaging services for New York Medicaid FFS beneficiaries. Update 05/19/2020: CMS will host a Special Open Door Forum call to discuss the Prior Authorization Process and Requirements for Certain Outpatient Hospital Department Services on Thursday, May 28, from 1:30p.m. Forms & Documents for Providers Here are some common forms and documents used by provider offices. This will allow you to manage time-sensitive clinical conditions while avoiding unnecessary trips to the Emergency Department. Radiology prior authorization services are now available so that radiology practices do not have to spend their time obtaining pre-authorizations and following up with clinical documentation. You can get a new form at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227). Prescriptions for medications requiring prior approval or for medications not included on the Molina Healthcare Drug Formulary may be … page 1 of 2 NYS Medicaid Prior Authorization Request Form For Prescriptions Rationale for Exception Request or Prior Authorization - All information must be complete and legible Patient Information 1. As is often the case, the key to an accurate diagnosis is based on performing the correct diagnostic studies during the most critical window of opportunity. A radiologist will quickly call you with the interpretation of the study. The program is applied to outpatient non-emergency advanced imaging procedures, for fee-for-service beneficiaries. ambulance company may send a request for prior authorization to Medicare before your fourth round trip in a 30-day period This way you and the company will know earlier in the process if Medicare is likely to cover your ambulance services If your prior authorization request isn’t … In addition to being able to obtain plain films without Prior Authorization in the office setting or at a freestanding imaging center, both Zwanger-Pesiri and RadNet facilities will provide additional imaging services with no PA required. ©2019 HealthCare Partners, MSO. For additional assistance with urgent imaging (or other time-sensitive clinical needs) you can also contact the HCP RTR™ line. Radiology. The site is updated regularly to meet the ever-growing needs of the New York State provider community.
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