ArchCare Advantage has a provider network of doctors, hospitals and other healthcare professionals that have an agreement with us to accept our payment and our members’ cost-sharing amount as payment in full. ArchCare has arranged for these providers to deliver covered services to members in our plan.
If members choose to go to a provider outside of the ArchCare network, they must pay for these services themselves except in limited situations (for example, emergency care). Neither the plan nor the original Medicare plan will pay for these services. If the circumstances are unusual or extraordinary and network providers are temporarily unavailable or inaccessible, our plan will cover emergent care to which prior authorization rules apply. The primary care physician or treating provider must call ArchCare Advantage to request prior approval before out-of-network services are rendered.
Part C service authorization requests can be submitted via fax to 1‑212‑524‑5163 or 1‑646‑233‑5745. Please be sure to include all supporting documents with your request.