Provider Information

YourCare Health Plan is monitoring COVID-19 developments on a daily basis.

YourCare has implemented processes to promptly answer all provider questions and concerns about the relevant covered services and ensure that providers deliver all necessary care to members.

 

Due to the likely increased demand for inpatient hospital services for COVID-19 patients, many hospitals are shifting staff resources from administrative functions to direct patient care. Insurance Law and Public Health Law §§ 4903 permit issuers to require preauthorization for health care services, other than emergency services. However, YourCare Health Plan understands that hospitals may lack the resources for staff to respond to utilization review requests for preauthorization while responding to the surge in patients due to COVID-19. Therefore YourCare Health Plan is suspending preauthorization review for all scheduled surgeries or inpatient admissions at hospitals for 90 days from March 20, 2020, subject to further evaluation as the COVID-19 situation develops. However, a hospital should use its best efforts to provide 48 hours’ notice to YourCare Health Plan after the admission to a hospital, including submitting information necessary for YourCare to assist in coordinating care and discharge planning. This information can be sent via fax 1-888-273-8296 or by emailing us at CPSS@Monroeplan.com. These services can be subject to retro review at a later time.

It is the expectation that hospital, rehabilitation and
skilled nursing facilities should make their best effort:

  • To provide 48 hours’ notice to the patient’s health plan after an admission, including information necessary for a health plan to assist in coordinating care and discharge planning; and
  • When discharging to a lower level of care, to arrange discharge to participating providers of the health plan’s network. Health plans should provide hospitals with an up-to-date list of all in-network rehabilitation facilities and skilled nursing facilities, in order to facilitate such discharges.