Changes to Pre-Certification Process for GHI PPO City of New York Employees/Non-Medicare Eligible Retirees with GHI PPO Benefits
Date Issued: 12/15/2015
Effective January 1, 2016, utilization management for the City of New York employees and non-Medicare eligible retirees with GHI PPO benefits will be managed by Empire BCBS for inpatient and outpatient services. EmblemHealth will process pre-certification requests for the following:
- Home Health Care
- Home Infusion Therapy (billed by a home infusion specialist)
- MRI/MRA/PET/CAT/NUCLEAR CARDIOLOGY/
- Nutritional Supplements and Enteral Formulas
To request pre-certification from EmblemHealth you may utilize our secure provider website: emblemhealth.com/Providers, or fax your request to 1-212-563-8391, or call the Coordinated Care Intake department at 1-800-223-9870.
To request pre-certification from Empire BCBS, please call 1-800-521-9574.
For a list of all services requiring Pre-Certification from Empire BCBS, please refer to our Provider Manual’s Directory and Care Management chapters.