Important information about utilization management
You can request a free copy of our UM criteria from Provider Services at 800-450-8753. Providers can discuss a UM denial decision with a physician reviewer by calling us toll free at the number listed below. To access UM criteria online, go to https://www11.empireblue.com/ny_search.html.
We are staffed with clinical professionals who coordinate our members’ care and are available 24/7 days a week to accept precertification requests. Secured voicemail is available during off-business hours. A clinical professional will return your call within the next business day. Our staff will identify themselves by name, title, and organization name when initiating or returning calls regarding UM issues.
You can submit precertification requests by:
- Faxing to 800-964-3627.
- Calling us at 800-450-8753.
- The Availity* Portal at availity.com.
Have questions about utilization decisions or the UM process?
Call our Clinical team at 410-981-4050 Monday through Friday from 8:30 a.m. to 5:30 p.m. Eastern time.
June 2021 Newsletter