New York (January 2, 2020) – EmblemHealth, one of the nation's largest non-profit health insurers, announced that effective January 1, 2020, it will significantly reduce the number of medical procedures for which members would require prior authorization before receiving care. The change will impact all of EmblemHealth’s health insurance plans, including Medicaid managed care, Medicare Advantage, coverage offered through employers, and Individual Market plans on the Exchange.
“EmblemHealth is transforming all of its operations. As part of that effort, we are reducing red tape and simplifying administrative processes for our clinical partners. This has led us to cut prior authorization requirements in half,” said Karen Ignagni, President and CEO of EmblemHealth. “Through careful analysis of our data, we identified services that almost always get approved. Not requiring prior authorization of those services, such as surgical procedures where patients are going to the hospital (i.e. some cardiac and vascular procedures, gallbladder removal, and treatment of glaucoma), will ensure that our members are receiving the care they need quickly and efficiently. Looking forward, we will continue to review our data with the goal of finding additional ways to reduce red tape and simplify administrative procedures.”
The decision was driven by rigorous data analysis and modeled on nationally established best practices for both ensuring people receive high-quality, affordable care, while allowing providers to more fully devote their attention to providing the care people need. This effort is an integral part of EmblemHealth’s ongoing efforts to use technology and information to work in partnership with our providers to provide the best care and support our members.
For additional information regarding the changes to the preauthorization requirements and EmblemHealth’s philosophy, please click here.
EmblemHealth is one of the nation’s largest nonprofit health insurers, with 3.1 million members and an 80-year legacy of serving New York’s communities. The company offers a full range of commercial and government-sponsored health plans to employers, individuals and families, as well as convenient community resources. As a market leader in value-based care, EmblemHealth partners with top doctors and hospitals to deliver quality, affordable care. For more information, visit emblemhealth.com.