Medicare AdvantagePrior AuthHigh impact
February 2020 In The Know
EmblemHealth·NY · Cardiology, Radiation Oncology, Radiology·Provider News
Effective date
Feb 1, 2020
We identified it
Jun 20, 2026
Summary
EmblemHealth PPO members are transitioning to new alphanumeric member IDs starting with 'K' and will require preauthorization through eviCore for radiation therapy and cardiology imaging. New Medicare site of service requirements became effective February 1, 2020.
Action Required
Immediately: Update billing system to recognize new EmblemHealth PPO member IDs that are 11-digit alphanumeric starting with 'K'. Train staff to obtain preauthorization through eviCore portal (preferred) at evicore.com or phone 800-835-7064 for all radiation therapy and cardiology imaging services for members with new 'K' IDs. Update encounter forms to prompt for preauth verification. Verify current network participation in Provider Portal under Practice/Provider Profile. Claims will be denied without proper preauthorization for affected services.