New York Medicaid: Prior authorization process update
Last modified: Sept. 29, 2023
Update: Edited the phone number for prior authorization questions
For dates of service on or after July 1, 2023, Optum® will conduct medical necessity reviews for outpatient physical, occupational and speech therapy services.
We require prior authorization for outpatient physical, occupational and speech therapy services for UnitedHealthcare Community Plan of New York members with the following plans:
- UnitedHealthcare Community Plans (New York State Medicaid Managed Care Plan)
- UnitedHealthcare Wellness4Me Plan (Health and Recovery Plan – HARP)
- Child Health Plus plans
- Essential Plan
We must receive your prior authorization request before the date of service. Claims will be denied if prior authorization is not on file before the date of service; members cannot be balance billed.
To submit a prior authorization
You can submit your prior authorization request using the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal.
The following documentation is required when submitting a prior authorization request for physical, occupational and speech therapy services:
- Signed referral obtained at the time of the evaluation
- Current evaluation report and plan of care
- Current progress report or the member’s most recent daily treatment notes
Coverage determination guidelines
See our coverage determination guidelines for documentation requirements and additional information.
A full list of the therapy codes requiring prior authorization is at UHCprovider.com/priorauth.
Questions?
Please call 866-362-3368.
