METROPLUS suspends ALL authorization requirements

Due to 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.

In 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.

This means :

  • For any services with a date of service through April 20th, MetroPlus will not require prior authorization for payment to be made.
  • For any ongoing service approvals that expire during the next thirty, no authorization is necessary at this time.
  • There 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.
  • No authorization numbers will be issued.
  • Existing Pharmacy, DME, and Dental Prior Authorization requirements are not being waived and will remain in effect.
  • Out of Network services will be paid without prior authorization for medically appropriate services.
  • For 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.

Click Here For More Information From DFS