Empire Plan Programs and Administrators
To reach any of The Empire Plan program administrators, call toll free 1-877-7-NYSHIP (1-877-769-7447). When you call, listen carefully to your choices and press or say your selection at any time during the message. Follow the instructions and you'll automatically be connected to the appropriate program.
Hospital Program Anthem Blue Cross, New York State Service Center, P.O. Box 1407, Church Street Station, New York, NY 10008-1407. Website: www.anthembluecross.com.
Call the Plan and press or say 2 to reach the Hospital Program for information regarding hospital and related services.
Benefits Management Program for Preadmission Certification You must call the Hospital Program before a scheduled hospital admission, within 48 hours after an emergency or urgent hospital admission and before admission or transfer to a skilled nursing facility (includes rehabilitation facilities). Preadmission certification is not required for maternity admissions, however, you must call when admitted due to complications related to your pregnancy or for any reason other than the delivery of your baby.
Centers of Excellence for Transplants Program You must call the Hospital Program before a hospital admission for the following transplant surgeries: bone marrow, peripheral stem cell, cord blood stem cell, heart, heart-lung, kidney, liver, lung, pancreas/pancreas after kidney, peripheral stem cell and simultaneous kidney-pancreas. Call for information about Centers of Excellence.
Medical/Surgical Program UnitedHealthcare Insurance Company of New York, P.O. Box 1600, Kingston, NY 12402-1600. Website: www.myuhc.com. Call the Plan and press or say 1 to reach the Medical/Surgical Program for information on benefits under the Participating Provider, Basic Medical Provider Discount and Basic Medical Programs, predetermination of benefits, claims and participating providers.
Managed Physical Medicine Program/MPMP Call the Medical Program for information on benefits and to find network providers for chiropractic treatment, physical therapy and occupational therapy. If you do not use network providers, you will receive a significantly lower level of benefits.
Benefits Management Program for Prospective Procedure Review of MRI, MRA, CT Scans, PET scans and Nuclear Medicine tests You must call the Medical Program before having an elective (scheduled) procedure or nuclear medicine test.
Home Care Advocacy Program (HCAP) You must call the Medical Program to arrange for paid-in-full home care services, enteral formulas, diabetic shoes and/or durable medical equipment/supplies. If you do not follow HCAP requirements, you will receive a significantly lower level of benefits. You must also call for HCAP approval of an external mastectomy prosthesis costing $1,000 or more.
Centers of Excellence for Cancer Program You must call the Medical Program to participate in The Empire Plan Centers of Excellence for Cancer Program.
Mental Health and Substance Use Program Carelon Behavioral Health, Inc., PO Box 1850, Hicksville, NY 11802; Website: www.achievesolutions.net/empireplan. To ensure the highest level of benefits, call the Mental Health and Substance Use Program before seeking certain services from a mental health or substance use provider, including treatment for alcoholism. Some services require precertification to confirm medical necessity before starting treatment. For a list of those services, call The Empire Plan and press or say 3 then select the Clinical Referral Line to find out more about precertification. In a life-threatening situation, go to the nearest hospital emergency department. You or a designee should call the Program within 48 hours, or as soon as reasonably possible, after an emergency admission. The Mental Health and Substance Use Program's Clinical Referral Line is available 24 hours a day, 7 days a week.
Prescription Drug Program CVS Caremark grievances, prior authorization documentation, general correspondence: Empire Plan Prescription Drug Program, CVS Caremark, Customer Care Correspondence, P.O. Box 6590, Lee's Summit, MO 64064-6590. Website: www.cs.ny.gov/empireplanrxprogram
Call the Plan and press or say 4 to reach the Prescription Drug Program. For the most current list of prior authorization drugs, call The Empire Plan or go to www.cs.ny.gov/empireplanrxprogram. See your Empire Plan Certificate for address information for appeals, claims and the mail service pharmacy.
Empire Plan Medicare Rx Program Silverscript prior authorization documentation, general correspondence: SilverScript Insurance Company, P.O. Box 52067, Phoenix, AZ 85072-2067. Website: www.cs.ny.gov/empireplanrxprogram. For the most current list of prior authorization drugs, call The Empire Plan or go to www.cs.ny.gov/empireplanrxprogram. See your Empire Plan Certificate for address information for appeals, grievances, claims and the mail service pharmacy.
Empire Plan NurseLineSM Call for health information and support, 24 hours a day, seven days a week.
Teletypewriter (TTY) numbers for callers when using a TTY device because of a hearing or speech disability:
- Anthem Blue Cross TTY only: 711
- UnitedHealthcare TTY only: 1-888-697-9054
- Carelon Behavioral Health, Inc. TTY only: 1-855-643-1476
- CVS Caremark TTY only: 711
- The Empire Plan Medicare Rx Program TTY only: 711