Skip Navigation

Important Message from MetroPlusHealth to Our Providers

Use our Provider Authorization Grid for Medical Services below to determine what prior authorization requirements are applicable for various plans like Medicaid, Child Health Plus, MetroPlusHealth Gold, and Medicare.

Download the file for Behavioral Health authorizations below.

In keeping with DFS guidance, MetroPlusHealth’s UM protocols resumed on June 22, 2020, including resuming issuing Prior Approvals and performing concurrent review.

Helpful Resources:

Authorization Grids

Medical Services Prior Authorization Request Grid

Download Download

BH & HCBS Services Prior Authorization Grid

Download Download

Medical Benefit Drug Prior Authorization Grid

Download Download

Toolkit / Resources:

Plans and Benefits Plans and Benefits
Quick Reference Guide Quick Reference Guide
Authorization Grid Authorization Grid
Clinical Policies Clinical Policies
Behavioral Health Behavioral Health
Pharmacy Resources Pharmacy Resources
Provider News Provider News
Provider Tools Provider Tools
Provider Forms Provider Forms
Claims and Billing Claims and Billing
last updated: August 15, 2022

Ready to Join Us?

Talk to us about questions or concerns

 1.866.496.6636 1.866.496.6636

Monday–Saturday | 8 a.m.–8 p.m. (ET)
Sunday | 9 a.m.–5 p.m. (ET)

Already A Member?

Talk To Us About Any Questions or Concerns

 1.800.303.9626 1.800.303.9626

Monday–Saturday | 8 a.m.–6 p.m. (ET)
Sunday | 9 a.m.–5 p.m. (ET)

morshedf_MPH_Web_Headshot_8-30
liulu_MPH_Web_Headshot_8-29
santic_MPH_Web_Headshot_8-30
marshgu_MPH_Web_Headshot_8-29
lugocl _MPH_Web_Headshot_8-29

Speak To Someone In Your Community

Find someone in your neighborhood and in your language

Virtual Office Phone Book