Treatment Authorizations & Variances Requests

Medical providers should submit their Attending Doctor's Request for Authorization (C-4Auth) requests and Medical Treatment Guideline (MTG) Variance Requests, forms MG-2 and MG-2.1, to the MTG teams in their respective NYSIF business offices. Please note your respective NYSIF business office e-mail, fax and claim unit numbers provided below:

NYSIF Medical Treatment Authorization and Variance Request Teams
Office MTG Shared E-mail Box MTG Shared Fax Claim Units
CLIO mtg-clio@nysif.com (315) 453-6648
415
NYC Claims Division 1 mtg-nyc-claims1@nysif.com (212) 312-7938
301, 302, 303, 304, 305, 306, 307, 308, 362, 363, 364, 365
NYC Claims Division 1 mtg-nyc-claims1@nysif.com (212) 312-7470
28, 29, 321, 323, 324, 328, 329, 370, 371, 372, 373
NYC Claims Division 2 mtg-nyc-claims2@nysif.com (212)-587-9294 020, 050, 057, 059, 024, 311, 331, 367, 381
NYC Claims Division 2 mtg-nyc-claims2@nysif.com (212) 587-9295 052, 053, 054, 058, 204, 327, 361, 366
NASSAU mtg-nassau@nysif.com (631) 756-4206 100, 102, 104, 105, 106, 107, 108, 109, 110, 111, 113, 114, 116, 117, 118, 119, 121, 122, 123, 124, 125, 126, 127, 129, 141, 142, 199, 213
SUFFOLK mtg-suffolk@nysif.com (631) 756-4272 55, 217, 235, 236, 237, 238, 239, 240, 241, 242, 243, 244, 245, 246, 247, 248, 249, 250, 251, 252, 253, 254, 255, 256, 257, 260, 261, 262, 263
WHITE PLAINS mtg-whiteplains@nysif.com
(914) 701-2188 145, 153, 154, 155, 156, 157, 162, 163, 164, 165, 166, 167, 168, 169, 170, 171, 172, 173, 174, 175, 176, 177, 179, 190, 191, 215, 225
ALBANY mtg-albany@nysif.com (518) 437-8997 25, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 180, 181, 182, 183, 184, 185, 212, 222
BUFFALO mtg-buffalo@nysif.com (716) 851-2096 80, 81, 82, 83, 84, 85, 86, 89, 140, 146, 202, 205, 206, 207, 208, 209, 218
ROCHESTER mtg-rochester@nysif.com (585) 258-2004 70, 71, 72, 74, 77, 78, 79, 216
SYRACUSE mtg-syracuse@nysif.com
(315) 453-8337 60, 61, 62, 63, 66, 67, 130, 131, 132, 133, 138, 139, 214, 224
BINGHAMTON mtg-binghamton@nysif.com
(607) 741-5605 281, 282, 283, 284, 285, 286, 287, 288, 289

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