Authorization Grids

Authorization Grids are now available for Medicare, Medicaid, Child Health Plus, and NY State of Health Marketplace plans, and are effective for dates of service occurring on or after the dates below.


Medicaid, Child Health Plus, and HealthierLife (HARP) 

Authorization Grid Detail, Effective September 1, 2018 (PDF)

Authorization Grid Detail, Effective July 1, 2018 (PDF)

Authorization Grid Detail, Effective June 1, 2018 (PDF)

Authorization Grid Detail, Effective May 1, 2018 (PDF)

Authorization Grid Detail, Effective April 1, 2018 (PDF)

Authorization Grid Detail, Effective February 1, 2018 (PDF)

Authorization Grid Detail, Effective January 1, 2018 (PDF)


Medicare

Authorization Grid Detail, Effective September 1, 2018 (PDF)

Authorization Grid Detail, Effective July 1, 2018 (PDF)

Authorization Grid Detail, Effective June 1, 2018 (PDF)

Authorization Grid Detail, Effective May 1, 2018 (PDF)

Authorization Grid Detail, Effective April 1, 2018 (PDF)

Authorization Grid Detail, Effective February 1, 2018 (PDF)

Authorization Grid Detail, Effective January 1, 2018 (PDF)


Metal-Level Products (Qualified Health Plans)

Authorization Grid Detail, Effective September 1, 2018 (PDF)

Authorization Grid Detail, Effective July 1, 2018 (PDF)

Authorization Grid Detail, Effective June 1, 2018 (PDF)

Authorization Grid Detail, Effective May 1, 2018 (PDF)

Authorization Grid Detail, Effective April 1, 2018 (PDF)

Authorization Grid Detail, Effective February 1, 2018 (PDF)

Authorization Grid Detail, Effective January 1, 2018 (PDF)


Essential Plan

Authorization Grid Detail, Effective September 1, 2018 (PDF)

Authorization Grid Detail, Effective July 1, 2018 (PDF)

Authorization Grid Detail, Effective June 1, 2018 (PDF)

Authorization Grid Detail, Effective May 1, 2018 (PDF)

Authorization Grid Detail, Effective April 1, 2018 (PDF)

Authorization Grid Detail, Effective February 1, 2018 (PDF)

Authorization Grid Detail, Effective January 1, 2018 (PDF)

Provider Access Online

Verify member eligibility, check claims status, and more.

eviCore Healthcare

Access the eviCore utilization management system.

Manuals and Forms

Provider manuals, tip sheets, important forms, and applications. 

Pharmacy Services

Formularies, utilization management programs, general pharmacy updates, and specialty drug programs.