NY Manual
SHP Manual

New York Provider Manual
X Medicare Member Reimbursement Form | XI-B Pre-authorization Guidelines - Leaf Plans

Appendix XI — Preauthorization Guidelines by Service Type

Appendix XI-A — Preauthorization Guidelines for Healthfirst Medicaid, Child Health Plus, Medicare, and CompleteCare Plans

Preauthorization is not a guarantee of payment. The member’s eligibility determines benefits. Policies are subject to change. Written formal referrals are not required for all Healthfirst plan in-network providers. Members should always be referred and receive care from in-network specialists.

Please contact Medical Management for prior authorization questions at the number listed on the attached grids.

 

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Preauthorization is not a guarantee of payment. Payment by Healthfirst for services provided is contingent upon the member’s active membership in Healthfirst at the time of service or when treatment was rendered. Policies are subject to change.

  • For preauthorization for the services listed above or to notify Healthfirst of an admission, contact the Medical Management department at 1-888-394-4327.

  • For advance imaging and radiology preauthorization, please contact Evicore at 1-877-773-6964.

  • For preauthorization of surgical procedures of the eye, please contact Davis Vision at 1-877-773-6964.

  • For information on chiropractic services, please contact ASH at 1-800-972-4226.

  • For pharmacy authorizations, please contact CVS Caremark at 1-800-294-5979.

  • For Physical, Occupational, Speech Therapy, please contact Orthonet at 1-844-641-5629

  • For Applied Behavioral Analysis Services, please contact Beacon at 1-855-371-9228