Medicare AdvantagePrior AuthHigh impact
January 2020 In The Know
EmblemHealth·NY·Provider News
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
EmblemHealth simplified preauthorization requirements effective January 1, 2020, removing the need to preauthorize 99 site-of-service codes for pediatric Medicaid and Commercial members. New Medicare site-of-service requirements begin February 1, 2020, and specialty drug infusions will require home delivery through Accredo starting March 1, 2020.
Action Required
Immediately: Update preauthorization workflows to remove requirements for 99 site-of-service codes for pediatric Medicaid and Commercial members. By February 1, 2020: Billing team must implement new Medicare site-of-service requirements. By March 1, 2020: Stop billing outpatient infusion services for specialty drugs on Accredo's list - members must transition to home infusion or pay full cost.