CommercialAdministrativeHigh impact
August 2019 In The Know
EmblemHealth·NY·Provider News
Effective date
Sep 1, 2019
We identified it
Jun 20, 2026
Summary
EmblemHealth is implementing multiple changes starting September 1, 2019, including new site of service pre-authorization requirements for HIP commercial and Medicaid, new referral numbering formats (9-digit numbers only), and GHI PPO member migrations to a new claims platform starting October 1.
Action Required
By September 1, 2019: Billing team must update systems to recognize new 9-digit referral numbers (format: 002008078) alongside existing PF and QF formats. Starting October 1, 2019: Verify current member ID cards at each appointment for GHI PPO members and submit claims using the applicable member ID in effect on date of service. Update pre-authorization workflows for HIP commercial and Medicaid members for specific sites of service.