Medical Physician Administered Drug Prior Authorization Grids
Dear MetroPlusHealth Provider,
We are committed to streamlining the authorization process for our provider partners. Our Provider Authorizations page offers easy access to prior authorization guidelines, request forms, and service-specific requirements to support timely, coordinated care for our members. Whether you are requesting medical, behavioral health, or pharmacy authorizations, we provide the tools and resources you need to deliver high-quality care without delay.
Under the Helpful Resources tab, you will find that our Medical Physician Administered Drug Prior Authorization Grids are now organized by MetroPlusHealth Product or Line of Business, rather than presented as a single comprehensive grid. This change is intended to optimize your time when using this resource, allowing you to quickly locate the information you need and return to caring for our members.
Medical Physician Administered Drug Authorization Grids
- Medical Benefit Physician-Administered Drug Prior Authorization Grid: Medicaid, Partnership in Care (PIC) HIV-SNP, Enhanced (HARP) Plan
- Medical Benefit Physician-Administered Drug Prior Authorization Grid: Child Health Plus (CHP), Essential Plan (EP), Marketplace Plans (QHP), Gold (NYC Employees), GoldCare (NYC based employer groups)
- Medical Benefit Physician-Administered Drug Prior Authorization & Step Therapy Grid: Medicare Advantage, UltraCare (HMO D-SNP)
It is not advised to save these grids for reuse. Best practice is to always refer to our website and use the most current grid available, as changes may occur.
If you have any questions regarding this memo, please contact the Provider Relations team at [email protected].
Thank you,
MetroPlusHealth