We are aware of issues with CareAdvance Provider being slow and timing out and we are working to resolve the issue.
Please continue to enter authorizations through the system.
They are being saved and processed internally, although you may not see the result due to the system delays.
Authorizations entered today will be available for review tomorrow.
We apologize for any inconvenience at this time; we are working on making your experience better.
Learn how to use our new CareAdvance tool with training materials located on our website under Resources > Staff Training > Presentations & Guidebooks. For additional information view FAQ's Open a PDF.
If you receive an error message stating "You have no associated provider sets", we can help you; please email your Web Username and Individual or Group NPI to CAPAdministrator@excellus.com to update the system.If you have any questions, please contact your Provider Relations Representative.
- Please review the eMedNY website for benefit coverage of specific codes prior to submitting a preauthorization request for MMC or HARP members.
The medical services including provider administered drugs below require prior review by the plan to determine clinical medical necessity.
The services below require prior review by the Plan to determine clinical medical necessity for all places of service. Not all services are covered by all medical plans. There may be services that require preauthorization or notification that do not require clinical review. Final determination of coverage is subject to the member’s benefits and eligibility on the date of service.
- All eviCore services can also be validated for prior authorization requirements via eviCore.com
Who Can Request: For HMO/POS plans, the member’s PCP or specialist with a valid referral. Other members, the member's PCP or treating provider.
Medical Health Procedure Codes Requiring Prior Authorization:
- Medical Prior Authorization Code List - November 1, 2020Open a PDF
- Medical Prior Authorization Code List - October 15, 2020Open a PDF
- Durable Medical Equipment - October 15, 2020Open a PDF
- Durable Medical Equipment - August 1, 2020Open a PDF
- Medical Specialty Drug (For Commercial, Exchange, and Medicare)Open a PDF
- Medical Specialty Drug (For Medicaid, Safety Net, and Essential Plan)Open a PDF
- eviCore Codes Requiring Preauthorization - November 1, 2020Open a PDF
- eviCore Codes Requiring Preauthorization - November 27, 2019Open a PDF
Behavioral Health Procedure Codes Requiring Preauthorization: