Get Nys Medicaid Prior Authorization Request Form For Prescriptions - Affinityplan

Under medical and prescription drug plans, some treatments and medications may need approval from your health insurance carrier before you receive care. Prior authorization is usually required if you need a complex treatment or prescription. Coverage will not happen without it.

The services most often requiring prior approval are durable medical equipment, skilled nursing facility stays, and Part B drugs. But, each Advantage plan is different. If you have an Advantage plan, contact your plan provider to determine if or when prior authorization is necessary.

Note: All planned, elective inpatient service requests require prior authorization.

Note: All planned, elective inpatient service requests require prior authorization.

Please call us at 800.753. 2851 to submit a verbal prior authorization request if you are unable to use Electronic Prior Authorization. Prior Authorization criteria is available upon request.

Medicaid members have comprehensive drug coverage and equitable access to an extensive network of over 5,000 pharmacy providers. This transition does not apply to Managed Long Term Care plans (e.g., PACE, MAP, MLTC) or the Essential Plan.

Prescribers obtain prior authorization for all these programs by calling the Medicaid Pharmacy Prior Authorization Clinical Call Center at 1-877-309-9493.

Prior authorization (also called “preauthorization” and “precertification”) refers to a requirement by health plans for patients to obtain approval of a health care service or medication before the care is provided. This allows the plan to evaluate whether care is medically necessary and otherwise covered.