Medicare AdvantagePrior AuthHigh impact
April 2020 In The Know
EmblemHealth·NY·Provider News
Effective date
Mar 20, 2020
We identified it
Jun 20, 2026
Summary
EmblemHealth updated COVID-19 policies including expanded telehealth coverage, suspended utilization management requirements for hospital services for 90 days starting March 20, and extended these changes to Medicare Advantage plans. New Child Health Plus ID cards will be issued May 1, 2020 showing referral requirements.
Action Required
Immediately: Stop requesting prior authorization for inpatient hospital and emergency services through June 18, 2020 (90 days from March 20). Update billing workflows to reflect suspended utilization management requirements for Medicare Advantage plans. By May 1, 2020: Update patient registration to recognize new Child Health Plus ID cards showing 'CHILD' as program and referral requirements. Review updated telehealth policies on EmblemHealth provider website for coverage changes.