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The Bridge Program

Learn how the Bridge Program applies to NYCE PPO, Large Group, and ASO plan members in 2026.

Who to Contact for Preauthorization

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All providers must verify member eligibility and benefits prior to rendering non-emergency services. See Clinical Corner for services that require Preauthorization. 

WHO TO CONTACT FOR PREAUTHORIZATION
EmblemHealth

EmblemHealth has partnered with various companies to provide special utilization management programs. See additional contacts below.

All HIP/EmblemHealth Insurance Company (formerly HIPIC) Plans:
Submit requests:
Online emblemhealth.com/providers
Call 866-447-9717 for more information or to use the IVR system.

 

EmblemHealth Plan, Inc. (formerly GHI):
Submit requests:
Call the Coordinated Care Intake department at
800-223-9870.

For New York City Employees PPO (NYCE PPO) members: Look up medical or pharmacy prior authorization requirements, submit medical prior authorization requests electronically, and view updates online at nyceppo.com/provider/prior-authorization.

 

Medicare PPO (EmblemHealth Plan, Inc. (formerly GHI)):
Submit requests:
Online at emblemhealth.com/providers
Call 866-557-7300 for more information or to use the IVR system.

For questions regarding the preauthorization process or the status of a specific request, call Customer Service at
877-244-4466.

For New York City Employees PPO (NYCE PPO) members: Look up medical or pharmacy prior authorization requirements, submit medical prior authorization requests electronically, and view updates online at nyceppo.com/provider/prior-authorization.

 

Skilled Nursing Facility; Inpatient Rehabilitation Facility; Long-Term Care Facility; Home Health Care
Submit requests:
Online at emblemhealth.com/providers
Call 877-833-2729.
Managing Entity Partners
(Applicable to Health Insurance Plan of Greater New York (HIP) only)
HealthCare Partners Call 800-877-7587.
Fax 888-746-6433.
SOMOS IPA, LLC

Call 844-990-0255.
Fax 877-590-8003.
Vendor Partners
UnitedHealthcare For New York City Employees PPO (NYCE PPO) members: Look up medical or pharmacy prior authorization requirements, submit medical prior authorization requests electronically, and view updates online at nyceppo.com/provider/prior-authorization.
Behavioral Health Services
Emblem Behavioral Health Services Program

For members in plans underwritten by HIP or EmblemHealth Insurance Company (formerly HIPIC), submit requests:
Online at carelonbehavioralhealth.com/providers.
Call Carelon Behavioral Health (formerly Beacon Health Options) at 888-447-2526.
EmblemHealth Behavioral Management Program

For members in plans underwritten by EmblemHealth Plan, Inc. (formerly GHI), submit requests:
Online at carelonbehavioralhealth.com/providers.
Call Carelon Behavioral Health (formerly Beacon Health Options) at 888-447-2526.
Cardiology,  Radiology and Radiation Therapy Services; Durable Medical Equipment (DME)
eviCore

Submit requests:
Online at evicore.com
Call 866-417-2345 (for HIP members) or 800-835-7064 (for EmblemHealth Plan, Inc. (formerly GHI) members).
Spine Surgery and Pain Management Therapy Program
OrthoNet For forms via orthonet-online.com call 844-730-8503. Requests and supporting clinical information must be faxed to 844-296-4440.
Pharmacy Services (also see the Medical Pharmacy Preauthorization List)
EmblemHealth Pharmacy Benefit Services Call 877-444-3657, from 8 a.m. to 6 p.m., Monday through Friday.
Prime Therapeutics™

Pharmacy Benefit Drugs Reviews –
Online at covermymeds.com.
Fax 914-901-3741.
Commercial: Call 866-799-7919, 24/7/365.
Medicare: Call 866-799-7781, 24/7/365.

Medical Benefit Drug Reviews –
Commercial, Medicaid and Medicare Medical and all Home Infusion Therapy:
Online at gatewaypa.com.
Call 833-519-4548 from 8 a.m. to 6 p.m., Monday through Friday.
Fax 888-656-6671.
Magellan (on behalf of NYRx, the Medicaid pharmacy program)

Medicaid Pharmacy Drug Reviews:
Online at newyork.fhsc.com.
Fax 800-268-2990.
Call 877-309-9493, 24/7/365.
Dental Services
DentaQuest
(effective 09/01/2025)		 Call the Provider Hotline at 888-308-2508 from 8 a.m. to 5 p.m., Monday through Friday. 
Vision Services
EyeMed Medicaid: 877-324-2791.
Medicare: 844-790-3878.
Commercial (HMO, PPO, POS): 877-324-4063.
On/Off Individual and Group Exchange and Essential Plans: 877-324-6211. 

JP69830 04/2026