Provider Policies & Compliance

Compliance is Everybody's Responsibility

YourCare is committed to conducting its business with integrity and in accordance with all federal, state, and local laws to which its business activities are subject to. The Compliance department ensures that the entire YourCare organization, including employees and business partners, maintain the highest ethical and legal standards in our day-to-day activities and responsibilities.

Thank you for your interest in the compliance department. For questions, please contact:

ComplianceDepartment@YourCareHealthPlan.com


Clinical Practice Guidelines


Help us report possible fraud, waste or abuse

To report suspected fraud, waste, or abuse call 844.654.3977. You may also send an email to SIU@YourCareHealthPlan.com. (You may remain anonymous).

Other Helpful Links:

YourCare Medical Policies

YourCare adopts clinical criteria for utilization review decisions (or coverage determinations) that is based on credible scientific evidence and is recognized by the medical community. Guidelines take into account physician society recommendations, the views of the physicians practicing in relevant clinical areas, the needs of the members in consultation with participating providers, and other relevant factors to the extent practicable.

Criteria can be requested by calling 1 (800) 683-3781 or submitting a written request to 1 (888) 273-8296. Requests may also be submitted in writing to P.O. Box 240, Pittsford, N.Y. 14534. Once received, criteria will be provided verbally and/or in writing, whichever is preferred.

YourCare Medical Specialty Drug Policies

Vendor Medical Policies