CommercialPrior AuthHigh impact
Preauthorization Updates
EmblemHealth·Prior Authorization
Effective date
Aug 1, 2025
We identified it
Jun 20, 2026
Summary
EmblemHealth is removing 303 services from preauthorization requirements and adding 5 new codes. Starting August 1, 2025, some surgical procedures will require preauthorization when performed in outpatient hospital settings for members under 75 years old.
Action Required
Before August 1, 2025: Billing team must review the updated EmblemHealth Preauthorization Lists to identify which 303 codes no longer require prior auth and which 5 new codes now require it. Update billing system rules for outpatient hospital procedures (POS 19 and 22) to require preauthorization for members under 75. Download and implement the revised preauthorization lists for all EmblemHealth and ConnectiCare plans. Claims may be delayed or denied without proper preauthorization.