CommercialPrior AuthMedium impact
Keep Care In-Network
EmblemHealth·Provider News
Effective date
Mar 1, 2024
We identified it
Jun 20, 2026
Summary
EmblemHealth and ConnectiCare are reinforcing their requirement that providers refer members to in-network providers whenever available and appropriate. Out-of-network referrals for non-emergent care require prior authorization through the Utilization Management team unless no in-network provider is available with the needed skills or reasonable distance.
Action Required
Immediately: Update referral workflows to prioritize in-network providers for all EmblemHealth and ConnectiCare members. Staff must verify network status before referring and submit preauthorization requests through emblemhealth.com/providerportal or connecticare.com/providerportal for any out-of-network referrals. Document justification when in-network providers are unavailable due to skills or distance.