Changes to Medicare PPO Prior Approval Rules for PT/OT/STST

Date Issued: 5/8/2013

EmblemHealth will implement new prior approval rules for physical therapy, occupational therapy and speech therapy for our Medicare PPO members, effective August 1, 2013. Under the new policy, EmblemHealth will require prior approval for these services after the sixth visit. At present, prior approval is required after the twentieth visit.

How to Obtain Prior Approval

To obtain a prior approval, sign on to Fax the Prior Authorization request to 1-866-725-6603, or mail your request to:

Coordinated Care Unit
441 9th Avenue, 7th Floor
New York, NY 10001

Urgent or expedited prior approval requests required after business hours (Monday - Friday from 8:30 am - 5 pm) should be made by calling 1-866-557-7300. For questions regarding the status of a request submitted or the authorization process, call Customer Service at 1-212-615-4662 or toll free at 1-800-223-9870.