CommercialPrior AuthMedium impact
June 2019 In The Know
EmblemHealth·Provider News
Effective date
Aug 1, 2019
We identified it
Jun 20, 2026
Summary
EmblemHealth is adding 99 codes with site-of-service rules to their pre-authorization list for HIP Commercial and Medicaid members effective August 1, 2019. These procedures won't require prior auth if performed in office settings (POS 11) or ambulatory surgery centers (POS 24).
Action Required
By August 1, 2019: Billing team must review EmblemHealth's updated pre-authorization list in Clinical Corner to identify the 99 codes with new site-of-service rules. Update billing system to reflect that these codes don't require prior auth when performed in office settings (POS 11) or ambulatory surgery centers (POS 24). Ensure place of service codes are correctly entered on claims to avoid unnecessary prior authorization delays.