CommercialPrior AuthHigh impact
July 2019 In The Know
EmblemHealth·NY·Provider News
Effective date
Sep 1, 2019
We identified it
Jun 20, 2026
Summary
EmblemHealth is implementing new pre-authorization requirements for Commercial and Medicaid supplemental plans based on site of service, effective September 1, 2019. They are also launching a new Bridge Network for self-funded groups that will change claim payment processes.
Action Required
By September 1, 2019: Billing team must review and implement new pre-authorization requirements for EmblemHealth Commercial and Medicaid supplemental plans based on member plan type and site of service. Monitor EmblemHealth provider website for detailed pre-authorization list and Bridge Network claim payment process changes. Update staff training on new authorization workflows to prevent claim denials.