Who to Contact for Preauthorization

All providers must verify member eligibility and benefits prior to rendering non-emergency services. See Clinical Corner for services that require Preauthorization. 

WHO TO CONTACT FOR PREAUTHORIZATION
Managing Entity Instructions
EmblemHealth EmblemHealth has partnered with various companies to provide special utilization management programs. See additional contacts below.

All HIP/HIPIC Plans:

Submit requests:
Online emblemhealth.com/providers
Fax 866-215-2928
Call 866-447-9717 for more information or to use the IVR system.
Hospitals and skilled nursing facilities can verify Preauthorization status by reviewing their concurrent review status reports.

EmblemHealth EPO/PPO (GHI):
Submit requests:
Online if the member has not been migrated to our new systems and been assigned a new “K” ID number: emblemhealth.com/providers
Fax 212-563-8391
Call the Coordinated Care Intake department at
800-223-9870.
See Additional Preauthorization Procedures for GHI Practitioners for more information.

Medicare PPO (GHI):
Submit requests:
Online emblemhealth.com/providers
Fax 877-508-2643
Call 866-557-7300 for more information or to use the IVR system.
For questions regarding the Preauthorization process or the status of a specific request, call Customer Service at 877-244-4466.
See Additional Preauthorization Procedures for GHI Practitioners for more information.

ASO Bridge Members:
Follow rules applicable to HIP EPO members:
Submit requests:
Online* emblemhealth.com/providers
Fax 866-215-2928
Call 866-447-9717

*GHI-only providers must call or fax until system is updated.
Fax 866-215-2928
Call 877-833-2729
HealthCare Partners (Cohort 1 & Cohort 2) Call 800-877-7587
Fax 888-746-6433
Montefiore CMO (Commercial & Medicaid) Call 888-666-8326
For behavioral health services, call
800-401-4822.
SOMOS IPA, LLC Online smnyportal.valence.care
Fax 877-590-8003
Call 844-990-0255
Empire BCBS (NYC GHI PPO) Utilization management for GHI PPO City of New York employees and non-Medicare eligible retirees with GHI PPO benefits is managed by Empire BCBS for inpatient and outpatient services.
Call 800-521-9574
Fax 800-241-5308

For fertility prescriptions and infertility services, including artificial insemination and IVF:
Call WINFertility 833-439-1515

To see what needs authorization, use their look-up tool.
Behavioral Health Services
Emblem Behavioral Health Services Program For members in plans underwritten by HIP or HIPIC, submit requests:
Online: beaconhealthoptions.com/providers
Call Beacon Health Options at
888-447-2526
EmblemHealth Behavioral Management Program For members in plans underwritten by GHI, submit requests: Online: beaconhealthoptions.com/providers
Call Beacon Health Options at
800-692-2489
Montefiore UBA For Commercial and Medicaid members who have the Montefiore logo on the lower left corner of their ID card:
Call 800-401-4822
Cardiology and Radiology Services; Durable Medical Equipment (DME); Skilled Nursing Facility; Inpatient Rehabilitation Facility; Long-Term Care Facility; Home Health Care
eviCore Submit requests: Online: evicore.com or for post-acute care requests via Allscripts

Call:
866-417-2345 (for HIP members)
800-835-7064 (for EmblemHealth EPO/PPO (GHI) members)
Chiropractic Services; Outpatient Physical and Occupational Therapy
Palladian Submit requests:
Online: palladianhealth.com
Fax 716-809-8324
Call 877-774-7693
Spine Surgery and Pain Management Therapy Program
OrthoNet For forms via orthonet-online.com by calling 844-730-8503. Requests and supporting clinical information must be faxed to 844-296-4440.
Pharmacy Services
EmblemHealth Pharmacy Benefit Services Call 877-444-3657, Monday through Friday, 8 a.m. to 6 p.m.
Express Scripts

Commercial Pharmacy Drug Reviews: 
Fax 877-251-5896
Call 844-516-3324, 24/7/365

 

Commercial Medical Drug Reviews:
Fax 866-896-1209
Call 877-681-9866, Monday through Friday, 8 a.m. to 7 p.m.

 

Medicaid Pharmacy Drug Reviews: 
Fax 877-251-5896
Call 888-281-5539, 24/7/365

 

Medicaid Medical Drug Reviews: 
Fax 866‑896‑1209
Call 877-681-9866, 8 a.m. to 7 p.m., Monday through Friday 

 

Medicare Pharmacy Drug Reviews: 
Fax 877-251-5896
Call 877-920-1470, 24/7/365 

 

Medicare Medical Drug Reviews: 
Fax 866‑896‑1209
Call 877-681-9866, 8 a.m. to 7 p.m., Monday through Friday 

New Century Health Submit requests:
Online: my.newcenturyhealth.com
Fax 877-624-8602
Call 888-999-7713, option 6, 8 a.m. to 8 p.m., Monday through Friday
Specialty Pharmacy Program Submit requests:
Online: accredo.com
Fax 888-302-1028
Call 855-216-2166, Monday through Friday, 8:30 a.m. to 5 p.m.
Home Infusion Therapy Submit requests:
Online: Homeinfusion@emblemhealth.com
Fax 212-510-5978
Call 800-367-8103 (Voice Mail)
Dental Services
DentaQuest Call 844-822-8108, Monday to Friday from 8 a.m. to 5 p.m.
Vision Services
EyeMed Medicaid: 877-324-2791
Medicare: 844-790-3878
Commercial (HMO, PPO, POS):
877-324-4063

On/Off Individual and Group Exchange and Essential Plans: 877-324-6211