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)