Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with UnitedHealthcare Insurance Company of New York (Empire Plan / NYSHIP) before sending sensitive documents. FaxFlow is not affiliated with this organization.

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UnitedHealthcare Insurance Company of New York (Empire Plan / NYSHIP) fax number

(845) 336-7716

Empire Plan Medical/Surgical Program – Predeterminations

Used for: Claims submission and predetermination requests for Empire Plan benefits

Fax destination details

Department
Empire Plan Medical/Surgical Program – Predeterminations
Purpose
Claims submission and predetermination requests for Empire Plan benefits
Form
Predetermination Request — Predetermination Request (Empire Plan)
Address
505 Boices Lane, Kingston, NY 12401
Voice phone
1-877-769-7447

Before you send

  • Confirm that this exact department handles your document or request.
  • Check the organization website or call its main line for the current fax number.
  • Include a cover sheet and any case, member, claim, or form reference required.
  • Keep the delivery confirmation with your submission records.

Use this form to verify how much UnitedHealthcare may reimburse for proposed services prior to rendering; you may also request an appeal of a previously denied predetermination. Do not use for services outside the predetermination process; follow specific service-line instructions in the form.

Official form instructions are published as a downloadable file on the organization's website.

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