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Program Offerings
24/7 Nurse Call Line
Preventive Health
Managing Conditions
Advance Care Planning
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. Call our Member Care Management Team at 1-800-860-2619. There are no additional fees to participate in these programs.

Chronic Care Management

Care for members with long lasting or recurrent conditions
Our chronic care management programs offer your patients the opportunity to work directly with a nurse care manager. The goal is to develop a partnership between the member, the nurse case manager and the member's physician, in order to maximize the member's ability to control his or her chronic condition. Call our Member Care Management Team at 1-800-860-2619 or click on the area you would like more information about:
  • CAD Booklet (PDF)
  • Asthma Fact Sheet (PDF)

Complex Care Management

Care for members with potentially catastrophic illness
Our complex care management programs have been developed to assist patients with particular health conditions that require a greater intensity of management. Examples include cancer, HIV, Stroke, chronic pain, traumatic injuries and transplants. Call our Member Care Management Team at 1-800-860-2619 or click on the area you would like more information about:
  • Palliative Care

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.

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.

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