Medicare AdvantagePrior AuthHigh impact
December 2019 In The Know
EmblemHealth·NY·Provider News
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
EmblemHealth is significantly reducing preauthorization requirements effective January 1, 2020, affecting all plan types including Medicare, Medicaid, and Commercial plans. Additionally, new infertility treatment coverage requirements add 5 new CPT codes requiring preauthorization while removing 5 codes from the preauth list.
Action Required
By January 1, 2020: Billing team must update preauthorization lists in billing system for all EmblemHealth plans (Medicare, Medicaid, Commercial, Exchange). Download new preauthorization code lists from EmblemHealth provider website and update billing software rules. Remove codes that no longer require preauth and add 5 new fertility-related CPT codes that now require preauth. Update encounter forms and staff workflows accordingly.