Excellus Bluecross BlueShield logo
Login | Register | Forgot Username | Forgot Password
Program Offerings
ExerciseRewards
HealthyRewards
BlueHealthy Dollars
24/7 Nurse Call Line
Preventive Health
Managing Conditions
Advance Care Planning
Personal Health Advisor
Managing Conditions
Managing Conditions

Total Health Management

We can help you understand your condition, learn about treatment options, and understand the importance of following your doctor's plan. There are no additional fees to participate in these programs.

Call our Member Care Management Team at 1-800-860-2619 (TDD/TTY 1-800-421-1220) or email.
Hours: 8:00 a.m. - 4:30 p.m., Monday - Friday.

Managing Chronic Conditions

Asthma
Chronic Obstructive Pulmonary Disease (COPD)
Congestive Heart Failure
Coronary Artery Disease (CAD)
Depression
Diabetes

Managing Complex Conditions

Additional Resources

How Will My Care Be Approved?

Our clinical criteria listed below are evidenced based decision making guidelines. We also use guidelines from CMS (Centers for Medicare and Medicaid Services) and eMedNY when applicable.

  • View our Medical Policies
  • View InterQual® Criteria
  • Level of Care for Alcohol and Drug Treatment Referral (LOCADTR)

    The New York State Office of Alcoholism and Substance Abuse Services (OASAS) has created an online tool to make recommendations as to the appropriate level of care for individuals in need of substance use disorder treatment based on an individual's risks and resources. The Level of Care for Alcohol and Drug Treatment Referral (LOCADTR) is a clinical tool used with a provider's full assessment.

    LOCADTR 3.0 is a web based level of care determination application. NYS OASAS in partnership with The National Center on Addiction and Substance Abuse at Columbia University developed this tool to determine the most appropriate level of care for substance use disorder.

    LOCADTR does not constitute medical advice. Treating practitioners are responsible for the medical advice and for the treatment of their patients. As a result, we recommend that you review these criteria with your doctor to fully understand how the criteria related to your situation.

New Initiative to Improve Access to Opioid Use Disorder Treatment

Effective immediately, for our members with a primary diagnosis of moderate or severe opioid disorder, we will automatically approve all new requests received from New York providers for coverage (including preauthorization, if required) for an initial length of stay for the following services at any New York State facility licensed to provide such services without the need for a medical necessity review:

  • Acute detoxification: 5 days;
  • Inpatient rehabilitation: 14 days; and
  • Residential: 14 days.

Requests for coverage of any additional days, or for services at facilities outside of New York State, will continue to be reviewed in accordance with our standard clinical review policies and procedures. To learn more or to request assistance from a Behavioral Health Advocate, please call 1-844-809-7518.

Information about substance use disorder treatment resources in New York State is also available at the website of the New York State Office of Alcoholism and Substance Abuse Services.

Image: Together, we're better.
Home     News & Updates    Print Forms    About Us    Fraud & Abuse    Glossary    Accreditations   
Copyright © 2016, Excellus BlueCross BlueShield, a nonprofit independent licensee of the Blue Cross Blue Shield Association. All rights reserved. View our Privacy Policy for information on how we protect your privacy. Use of this site indicates your acceptance of our Terms of Use. Follow this link to view our 31 county New York State service area. You will need Internet Explorer or Firefox to use the secure features of this site.