New Empire Precertification Requirement (NYC Healthline)
Effective January 1, 2019, the following services will be added to Empire Blue Cross Blue Shield’s (BCBS) precertification list* for Site of Service review for groups utilizing the New York City Healthline to obtain a reference number:
- Cataract Surgery
- Knee Arthroscopy
Providers need to call to obtain a reference number when the place of service requested is a hospital-based outpatient center (POS 22). This can be done by calling the NYC Healthline at 800-521-9574 at least three weeks before the procedure. Site of service review encourages shifting care to a more cost effective setting; i.e. Ambulatory Surgery Center (ASC) or Office.
Once this process is engaged, The NYC Healthline will give you a list of convenient participating ASC facilities within your area. Your office team will be able to discuss options with the Healthline team. The EmblemHealth Provider Manual has been updated to reflect this change.
*This requirement only applies to New York City members whose care is managed through the NYC Healthline.