Our Interactive Care Reviewer (ICR) tool via Availity is the preferred method for submitting prior authorization requests, offering a streamlined and efficient experience for providers requesting inpatient and outpatient medical or behavioral health services for our members.
Empire BlueCross BlueShield HealthPlus (Empire) is available via phone or the Interactive Care Reviewer (ICR) 24 hours a day, 7 days a week to accept prior authorization (PA) requests. You can access the ICR from the Availity home page:
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Providers and staff can also contact Empire for help with prior authorization via the following methods:
The Medicaid-Approved Preferred Drug List (PDL) includes information such as mandatory generic requirements, prior authorization (PA), quantity limits, age limits or step therapy.
Pharmacy services billed with the following revenue codes always require prior authorization:
Behavioral health services billed with the following revenue codes ALWAYS require prior authorization:
Services billed with the following revenue codes always require prior authorization: