St Barnabas members included in special utilization management programs

Date Issued: 9/27/2018

St. Barnabas members included in special utilization management programs

Beginning on the dates listed below, St. Barnabas and Union Community Health Center primary care physicians are part of EmblemHealth’s special utilization management programs. The process for prior approval for these members is changing as follows:

Beginning July 1, 2018

The EmblemHealth Spine Surgery and Pain Management Therapies Program.

To obtain prior approval, complete an OrthoNet EmblemHealth Pain Management Fax Request form and fax it to OrthoNet at 844-296-4440. A link to the forms is located at the end of the Spine Surgery and Pain Management Therapies Program chapter.

Contact OrthoNet at 844-730-8503, Monday through Friday, 8:30 a.m. to 5:30 p.m., with any program questions. Lab Services are listed on the EmblemHealth Provider Office Lab list.

Beginning August 23, 2018

Radiology, Cardiology imaging, Durable Medical Equipment, Home Care Services, and Post-acute Care Services that include Home Health, Skilled Nursing Facilities (SNF), Inpatient Rehabilitation Facilities  (IRF), and Long-Term Acute Care Facilities (LTAC).  

For information on how to request prior approval, refer to the appropriate Provider Manual chapter.

For general inquiries regarding utilization management, contact our Provider Call Center at 866-447-9717. Our hours are 8 a.m. to 6 p.m., Monday through Friday. You may also use our Message Center at emblemhealth.com. Select "General Information" from the drop down menu on the "Ask a Question" page.