Prior authorization and notification requirements, Empire Plan supplement - 2022 UnitedHealthcare Administrative Guide

We require advance notification of the procedures and services listed in the chart below. These services are likely to identify members with unmet health care needs who will benefit from UnitedHealthcare’s programs, or those of other Empire Plan vendors. In general, depending on the program, members are responsible for either notifying Empire Plan program vendors of certain services or for using network care providers for these services.

Call 1-877-7-NYSHIP (1-877-769-7447) and follow the prompts to notify the appropriate program carrier/vendor as outlined below, or go to uhcprovider.com/paan.

This notification list may be modified. The presence or absence of a procedure or service on this list does not mean that benefit coverage exists for that procedure or service. The member benefit contract will determine whether a procedure or service is covered.

Service Contact

Advanced diagnostic imaging services

  • MRI
  • MRA
  • CT scan
  • PET scan
  • Nuclear medicine test
UnitedHealthcare Benefits Management Program 

Alcoholism treatment

 

Beacon Health Options, Inc.
Behavioral Health Program 

Chiropractic services

 

Managed Physical Network, Inc. (MPN) Managed Physical  Medicine Program 
DME and integral supplies UnitedHealthcare Home Care Advocacy Program 
Home health services that take the place of hospitalization UnitedHealthcare Home Care Advocacy Program
Home infusion therapy and enteral formula

(except administration of enteral formula through a tube for patients whose primary coverage is Medicare)

UnitedHealthcare Home Care Advocacy Program 
Home nursing services UnitedHealthcare Home Care Advocacy Program 

Hospital admissions

  • Elective, including maternity
  • Emergency/urgent (within 48 hours)
Empire BlueCross Benefits Management Program 
Mental health services Beacon Health Options, Inc. Behavioral Health Program
 
Physical therapy MPN
Managed Physical Medicine Program
 
Prescription drugs
As noted in Preferred Drug List or Flexible Formulary List
CVS Caremark
Prescription Drug Program 
Skilled nursing facility admissions Empire Blue Cross Blue Shield Benefits Management Program
 
Substance abuse services Beacon Health Options, Inc. Behavioral Health Program