CommercialPrior AuthHigh impact
Annual Review of Preauthorization Requirements – Scheduled Updates for July, September, and November 2022
EmblemHealth·Radiology·Prior Authorization
Effective date
Jul 1, 2022
We identified it
Jun 20, 2026
Summary
EmblemHealth is adding new CPT codes to their preauthorization requirements for advanced radiology services in partnership with eviCore, with changes rolling out on July 1, September 1, and November 1, 2022. Billing teams must obtain prior authorization for these newly added radiology procedures to avoid claim denials.
Action Required
By July 1, 2022: Billing team must review the EmblemHealth Preauthorization List updates on their website to identify newly added radiology CPT codes requiring prior authorization. Update billing system workflows to flag these codes for prior auth verification before scheduling or billing. Monitor for additional updates on September 1 and November 1, 2022. Claims submitted without required prior authorization will be denied.