CommercialPrior AuthHigh impact
Provider Portal – Accelerating Care by Simplifying Preauthorization and Clinical Reviews
EmblemHealth·NY, CT·Prior Authorization
We identified it
Jun 20, 2026
Summary
EmblemHealth and ConnectiCare have eliminated preauthorization requirements for scores of CPT codes and changed review requirements for approximately 400 inpatient diagnosis codes. They've also launched new provider portal functionality that accelerates preauthorization and clinical review decisions, eliminating the need for fax and phone submissions.
Action Required
Immediately: Billing team should review the updated preauthorization lists online (EmblemHealth/ConnectiCare Commercial/ConnectiCare Medicare) to identify which CPT codes no longer require preauthorization. Update billing system rules to remove prior auth requirements for eliminated codes. Train staff to use the new provider portal instead of fax/phone for faster preauthorization requests and clinical reviews. Update workflow to attach medical records and documents through the portal for preauthorization requests, concurrent reviews, and emergent inpatient admissions.