Some services in New York's Medical Treatment Guidelines require prior approval as special services. Providers request them with an MTG Special Services PAR in OnBoard, entering the CPT code, guideline site and reference, body part and side, then a statement of medical necessity with records attached. These requests were previously made on Form C-4AUTH, and the claim administrator has 15 calendar days to respond.
The Board-authorized treating provider makes the request, and delegates with their own Board-assigned user IDs can draft it for the provider's review. The claim administrator's reviewer, and a physician at Level 2, respond in OnBoard.
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MTG Special Services Prior Authorization Request (PAR)
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Special services required by the Medical Treatment Guidelines were previously requested on Form C-4AUTH, the Attending Doctor's Request for Authorization and Carrier's Response. Since May 2, 2022, they are requested through OnBoard as MTG Special Services PARs, and paper requests are not accepted.
Fifteen calendar days, extended to 30 if the claim administrator requests an independent medical examination or records review. The due date shows on the OnBoard Active tab, and if the claim administrator misses it, an Order of the Chair may be issued.
A grant in part or medical denial at Level 1 escalates automatically to Level 2 review by the claim administrator's physician. If Level 2 does not grant it, the provider may request Level 3 review by the Board's Medical Director's Office, whose Notice of Resolution on MTG requests is final.