Pre-authorization List

Date Issued: 11/30/2018

This is a complete list of all services requiring a Prior Approval for HIP members or a Pre-Certification for GHI members (jointly referred to as “pre-authorization”) subject to their benefit plan’s coverage for all places of service, including Office (POS 11). The list accounts for EmblemHealth’s medical policies, medical technology database, provider manual, and special utilization management programs. Pre-authorization is not a guarantee of payment. Payment is subject to a member’s eligibility for benefits on the date of service. Emergency services do not require a pre-authorization.