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Preauthorization Check for EmblemHealth HMO members:
  • This Preauthorization Check tool should be used for EmblemHealth members with
    an HMO plan.
  • Preauthorization depends on member eligibility on the date of service, contractual
    benefit limits, and whether the service is a covered benefit as described in a
    member’s plan documents. For example, all inpatient elective services, home care,
    and non-emergency transportation, if covered, require preauthorization. Members
    in some ASO plans do not need a preauthorization.
  • Some services are delegated to Vendors, please check the provider manual for
    those vendor programs.
Instructions:
  • Select the appropriate Line of Business (LOB) for the member’s plan and enter
    the procedure code (CPT or HCPCS code), diagnosis code, and place of service
    to see if a preauthorization is required.
  • Members using this tool: For accurate results, be sure to ask your doctor for
    the appropriate codes before using this tool. Members may also check their plan
    documents or call Customer Service at the number on their ID cards for more
    information.

Preauthorization Check
 
   
  Member LOB:    
         
  Procedure Code:


   

 
  Diagnosis Code:


   

 
  Place of Service: