CommercialPrior AuthHigh impact
Preauthorization Updates
EmblemHealth·Prior Authorization
Effective date
Apr 1, 2025
We identified it
Jun 20, 2026
Summary
EmblemHealth has updated their preauthorization lists across multiple products including GHI PPO City of New York, ConnectiCare, and EmblemHealth home infusion therapy drugs and pharmacy medical services. Billing teams need to review the updated preauthorization requirements to ensure proper prior authorization is obtained before services are rendered.
Action Required
By April 1, 2025: Billing team must access the updated preauthorization lists at emblemhealth.com/providers and review all changes to GHI PPO City of New York, ConnectiCare home infusion therapy drugs, EmblemHealth home infusion therapy drugs, and pharmacy medical preauthorization requirements. Update billing system rules and prior authorization workflows accordingly. Train front desk staff on new requirements. Claims submitted without required prior authorization will be denied.