Prior authorization

Our online prior authorization requirement search and submission tool allows providers to easily look up services for a specific member and determine if prior authorization is required or pre-determination recommended. Users can then submit requests for prior authorization or pre-determination using the same integrated tool.

Simply sign into the NYCE PPO secure provider portal and look up a patient using the Patient search feature to find plan-specific prior authorization requirements and submit a request for review, if required.

  • Prior Authorization

    Look up medical or pharmacy prior authorization requirements, submit medical prior authorization requests electronically and view updates online.

  • Medical pharmacy

    Submit medical pharmacy prior authorizations for dates of service after Jan. 1, 2026. 

    For medical pharmacy prior authorizations, please contact Prime Therapeutics Medical Pharmacy Solutions at 833-519-4548 or request online at GatewayPA.com.

  • Prime Therapeutics

    For pharmacy prior authorizations, please contact Prime Therapeutics Pharmacy Benefit Management at 866-799-7919 or request online CoverMyMeds.com.