Referrals and Authorizations
VNSNY CHOICE endorses the philosophy that clinical care is best rendered when a member’s PCP is given the authority and responsibility for coordinating the overall healthcare of a member.
That is why PCPs may make in-network referrals without obtaining prior authorization. However, authorization is required for referrals to out-of-network providers.
VNSNY CHOICE Providers managing patient referrals will find detailed information on policies and procedures for all CHOICE health plans in Section 8 of our Provider Manual.
Prior Authorization List
Some specific services covered by VNSNY CHOICE Medicare require prior authorization. These include, but are not limited to:
- Inpatient admissions (except in an emergency)
- Skilled nursing facility admissions
- Outpatient surgery
- Home health care services
- Certain diagnostic procedures
For more information, please see our complete list of services that require prior authorization for VNSNY CHOICE Total.
To request authorization from VNSNY CHOICE, please complete and fax this Prior Authorization Request Form.
CHOICE SelectHealth providers can use the SelectHealth Provider Directory to check whether a drug requires prior authorization. To request prescription coverage for a SelectHealth member, please download our Prior Authorization Form.
Last updated 6/26/2020