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
|
UnitedHealthcare Benefits Management Program |
Alcoholism treatment
|
Beacon Health Options, Inc. |
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
|
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 |