The following chart shows our preauthorization lists for your reference.
| Preauthorization Lists | |
|---|---|
| List | Description |
| EmblemHealth Preauthorization List | 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. The list applies to the following EmblemHealth lines of business:
|
| EmblemHealth Pharmacy Medical Preauthorization List | Notable changes are captured in the Revision History on the list. |
| Home Infusion Therapy Drug Preauthorization List | Notable changes are captured in the Revision History on the list. |
| GHI PPO City of New York Preauthorization List | This is an EXCLUSIVE list for GHI PPO City of New York members for services rendered by EmblemHealth’s providers, and this list applies to the following lines of business:
|
| ConnectiCare’s Coverage Guidelines and Preauthorization Lists | These Commercial and Medicare preauthorization rules apply to ConnectiCare members who are seen by EmblemHealth providers. See the Summaries of Companies, Lines of Business, Networks & Benefit Plans in our Provider Toolkit to see which ConnectiCare plans give their members access to EmblemHealth providers. |
To see full information on our Utilization Management programs, preauthorization requirements, and who conducts preauthorization reviews, see the EmblemHealth Provider Manual’s Care Management chapter and the Coverage Guidelines section of the ConnectiCare website.
