the serious impact on healthcare providers due to the COVID-19 pandemic,
effective March 20th, MetroPlus will no longer require prior-authorization for
most medical services. MetroPlus will follow the guidelines laid out in the NYS
Department of Financial Services Insurance Circular Letter regarding the Utilization
Review for Inpatient and Emergency Services.
addition, except for services listed below, for the next thirty days (through
April 20, 2020), MetroPlus has taken the additional step to suspend ALL
authorization requirements except for DMEPOS, Pharmacy, and Dental at least
until April 20, 2020.
any services with a date of service through April 20th, MetroPlus will not
require prior authorization for payment to be made.
any ongoing service approvals that expire during the next thirty, no
authorization is necessary at this time.
is no need to fax or call in requests for authorization for services
provided through April 20, 2020, as no one will respond to your request.
authorization numbers will be issued.
Pharmacy, DME, and Dental Prior Authorization requirements are not being
waived and will remain in effect.
of Network services will be paid without prior authorization for medically
any Out of Network services provided during this period without an
authorization, services will be reimbursed at default (Medicaid/Medicare)
rates for government programs and Medicare rate for commercial products.
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