April 01, 2023

New York Medicaid: Prior authorization process update

Last modified: Sept. 29, 2023
Update: Edited the phone number for prior authorization questions

For dates of service on or after July 1, 2023, Optum® will conduct medical necessity reviews for outpatient physical, occupational and speech therapy services. 

We require prior authorization for outpatient physical, occupational and speech therapy services for UnitedHealthcare Community Plan of New York members with the following plans:

  • UnitedHealthcare Community Plans (New York State Medicaid Managed Care Plan)
  • UnitedHealthcare Wellness4Me Plan (Health and Recovery Plan – HARP)
  • Child Health Plus plans
  • Essential Plan

We must receive your prior authorization request before the date of service. Claims will be denied if prior authorization is not on file before the date of service; members cannot be balance billed.

To submit a prior authorization

You can submit your prior authorization request using the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal.

The following documentation is required when submitting a prior authorization request for physical, occupational and speech therapy services:

  • Signed referral obtained at the time of the evaluation
  • Current evaluation report and plan of care
  • Current progress report or the member’s most recent daily treatment notes

Coverage determination guidelines

See our coverage determination guidelines for documentation requirements and additional information.

A full list of the therapy codes requiring prior authorization is at


Please call 866-362-3368.

Finding news icon

Discover more news

Personalized news icon

Get personalized news