Provider Resources

• Provider Manual
• Provider Quick Reference Guide
• Provider Newsletters
• Co-Pay Structure for 1199SEIU Greater New York Benefit Fund Members – Effective March 1, 2011

Forms For Provider Services

• Provider Demographic Information Change Request Form
• Provider Recruitment Form

Services Requiring Pre-Authorization

• Ambulatory Surgical Procedures
• HomeCare, Certain Outpatient, DME and Rx Services
• Chiropractic Services (refer to Reference Contact Guides)
• Hospital Services (refer to Reference Contact Guides)
• Certain MRA/MRI, CT/CTA, and PET imaging (refer to Forms for Authorization)

Forms for Authorization

• Service/Equipment Request for Authorization
• Home Oxygen Therapy Request for Authorization
• Prescription Request for Authorization
• PT/OT/ST Benefit Extension
• Radiology Prior Authorization Request Form
• Cardiac, Pulmonary Rehabilitation Request Form
• CareAllies Initial Pre-Certification Request Form
• Provenge Precertification Request

Reference Contact Guides

• Chiropractic Services
• Hospital Services
• Outpatient and Home Care Services
• Prescription Benefit Program
• Focus DRG Validation Program
• Outpatient Radiology Review Program