EmblemHealth Utilization Management Preauthorization List 1/1/2020 HIP & GHI PPO Non-City of New York

EmblemHealth Utilization Management Preauthorization List 1/1/2020 HIP & GHI PPO Non-City of New York

02/28/2020

EmblemHealth Preauthorization List.

 

Please click on the link above for a complete list of all services that require preauthorization.  The list indicates which CPT codes require preauthorization based on site of service and diagnosis codes.  It indicates which codes are handled by a vendor and it includes Pharmacy codes.

 

The list applies to the following EmblemHealth lines of business:

  • GHI Commercial non-City of New York
  • GHI Medicare non-City of New York
  • HIP Commercial
  • HIP Medicaid
  • HIP Medicare

Please be aware of the following information concerning the preauthorization list:

  • The creation of the list is inclusive of EH’s Medical Policies, MedTech Data base, Provider Manual, Vendor Management and Place of Service policies.
  • Preauthorization is required for all Inpatient types of care including Medical, Surgical, Hospice, Skilled Nursing Care, Rehabilitation care, in addition to DME and Homecare services.
  • In addition to the defined services we have identified specific CPT/HCPCS codes that require Preauthorization.
    • Including:
      • All non-emergency inpatient hospital admissions (acute, rehabilitation, behavioral health and skilled nursing facility care)
      • Home health care (nursing, PT, OT, ST, home infusion therapy)
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