How Does Prior Authorization Work in NYC's Medicare Advantage Plans?

What this video covers

This video walks through how prior authorization works under Medicare Advantage plans in New York City, including which services commonly require approval, how submission channels differ by carrier, and what timelines and appeal rights apply. It is aimed at practice managers and billing staff in the five boroughs who handle a mix of MA plans daily.

• Plans differ widely. Each NYC Medicare Advantage carrier keeps its own PA list and submission process, so verify requirements per plan, per service, every year.
• Check before scheduling. Confirm authorization requirements before booking procedures or imaging. Retroactive requests after service are far harder to win than upfront approvals.
• Timelines and expedited review. Standard MA determinations follow set timeframes, and expedited review applies when a delay could seriously harm the patient's health.
• Denials are appealable. MA denials carry structured appeal rights, and well-documented appeals overturn a meaningful share of initial denials when clinical evidence is complete.

Staffingly's authorization teams work daily inside Medicare Advantage portals for practices across New York and nationwide, serving 800+ US providers. Dedicated staff verify requirements, submit complete requests, and chase decisions with 24/7 coverage. HIPAA, SOC 2 Type II, and ISO 27001 compliant, with flat pricing from $399 weekly. Learn more about Staffingly’s Prior Authorization services.