UM & Medical Management

EmblemHealth is simplifying our utilization management (UM) rules. We are reducing your need to seek pre-authorization (PA) based on the member’s type of plan (Commercial, Medicaid and Medicare) and the selected site of service.

Please be aware that some of our policies and procedures may be affected by COVID-19 regulations published by state and federal regulators. Please review our Provider COVID-19 page to stay up-to-date on all changes.