Department
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Previous Fax Number
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New Fax Number
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Type of Faxes
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Behavioral Health Substance Abuse Requests
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646-829-1421
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833-663-1608
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All Substance Abuse Requests
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Behavioral Health Authorization Requests
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718-896-1784
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833-561-0094
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Behavioral Health Authorization Requests (Excluding Substance Abuse)
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Behavioral Health Children's Authorization
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347-690-7362
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833-663-1604
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All Children's Behavioral Health Authorizations
and Plans of Care (POC)
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Behavioral Health Court Orders
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877-584-9642
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877-584-9642
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All Court Orders for Behavioral Health
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Behavioral Health HARP Authorization
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347-868-6427
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833-561-0089
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All HARP Behavioral Health Authorizations
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Claims
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877-247-9187
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877-247-9187
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Claims Invoices
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Credentialing
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716-636-2522
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833-710-1981
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Initial Credentialing Application/Provider Data Form (Participating Contract/TIN Required) Re-credentialing Application/Information
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Government Affairs & Compliance
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718-362-1271
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833-710-1655
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Independent Dispute Resolution Entity (IDRE) Inquiries
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Government Affairs & Compliance
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315-849-3885
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833-710-1972
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Non-Discrimination Inquiries
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Medical Appeals
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718-393-6779
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833-710-2226
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Pre-Service Medical Appeals for all Non Long Term Care Members
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Member Services
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718-393-6635
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833-710-2220
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PCP Change Request Forms
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Member Services
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877-533-2402
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877-533-2403
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Health Care Proxy (Medicare)
Letter Log (Medicare and Medicaid)
Medicare Disenrollment
Pharmacy Faxes
Medicare Bills
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Member Services
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718-897-1988
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833-710-1775
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Baby Care Incentives
Children and Adult Medical Records
Health Care Proxy (Medicare)
Medicaid Letter Log (Legal)
MLTC Letter Log
W-9 Forms & Provider
Bills and Claims
Coverage of Benefits and Terminations
Health Care Proxy Medicaid
Pharmacy Reimbursements
Authorizations Requests
Summary of Doctor’s Appointment
Transportation Documents
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Member Services
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716-564-6250
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833-710-1777
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Transportation Authorizations for Non-Emergency Transportation
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Member Services
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718-896-6832
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833-710-1776
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Letter Log (Medicare and Medicaid)
Medicare HIPAA Letter
NYSARC Forms
Personal Care Services Faxes (Physician’s Order for Personal Care/Consumer Directed Personal Assistance)
Pharmacy Faxes
W-9 Providers/ Home Health Agency
Coordination of Benefits (COB)
Medicaid HIPAA Forms
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MLTC
|
716-803-8727
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833-710-1772
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MLTC Authorization Requests, Clinical Information and Notifications
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MLTC
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716-200-4637
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833-710-1659
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DUAL Members -
All DME & Authorization Requests
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MLTC
|
347-514-6161
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833-710-1973
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MLTC Members -SNF documents (Authorization Requests, Permanent Placement Forms, PRIs, Notice of Agreement to PP)
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MLTC
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716-898-0651
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833-710-1658
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MLTC Members - Appeal Requests
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Pharmacy - Medicaid/Exchange
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877-533-2405
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844-235-4852
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Pharmacy Benefit - Initial Request
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Pharmacy - Medicaid/Exchange
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877-533-2405
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844-235-5090
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Pharmacy Medical Benefit –
Initial Request
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*Pharmacy - Medicaid/Exchange
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877-533-2405
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888-865-6531
(Effective 10/2/2023)
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Pharmacy Benefit - Appeal Request
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*Pharmacy - Medicaid/Exchange
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877-533-2405
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844-235-5091
(Effective 11/1/2023)
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Pharmacy Medical Benefit - Appeal Request
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Pharmacy - Medicare
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877-882-5892
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844-235-5021
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Pharmacy Benefit - Initial Request
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*Pharmacy - Medicare
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877-882-5892
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844-235-5090
(Effective 11/1/2023)
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Pharmacy Medical Benefit - Initial Request
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*Pharmacy - Medicare
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877-882-5892
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833-757-0611
(Effective 11/1/2023)
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Pharmacy Medical Benefit - Appeal Request
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*Pharmacy - Medicare
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877-882-5892
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866-388-1766
(Effective 10/2/2023)
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Pharmacy Benefit - Appeal Request
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Provider Relations – Albany Region
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518-463-8820
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833-522-2805
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PR Related Communication
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Provider Relations – Buffalo Region
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716-200-1770
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833-710-1653
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PR Related Communication
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Provider Relations –
NYC Region
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718-896-1924
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833-522-2804
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PR Related Communication
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Provider Relations – Rochester Region
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585-785-4001
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833-710-1652
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PR Related Communication
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Provider Relations – Syracuse Region
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315-437-4875
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833-710-1923
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PR Related Communication
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Retention
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718-393-6484
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833-710-1648
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For members to submit documentation required by NYSoH, LDSS or HRA in reference to their Renewal or Enrollment Application. This can be extended for providers as well to send documentation relevant to a members Renewal or Enrollment application.
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Utilization Management
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716-462-4696
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833-710-1975
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Discharge Notices for Transition of Care Members Only
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Utilization Management
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716-200-1389
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800-860-8720
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DME Authorizations (excluding MLTC) Sleep Study Authorizations, Podiatry Services
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Utilization Management - Physical Health
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716-803-8307
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833-663-1611
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Authorization Requests and Clinical Documentation for Inpatient Rehab Requests (For Non Long Term Care Members)
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Utilization Management - Physical Health
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347-868-6411
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833-663-1602
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Authorization Requests and Clinical Documentation for Inpatient ER Requests (For all Non Long Term Care Members)
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