In the past several weeks, EmblemHealth and ConnectiCare began simplifying the delivery of quality care by eliminating the need for preauthorization on scores of CPT codes and changed the review requirements for approximately 400 inpatient elective/emergent diagnosis codes. These changes are part of a multiyear effort that, along with provider portal updates that streamline requests, is expected to save our providers time and effort. Large health systems in New York may save approximately 7,350 hours of staff time per year, while Connecticut health systems could save 3,980 hours per year.
New portal tools to save time
Key to the provider administrative savings is new functionality on the portal that gives clinicians an answer on their preauthorization requests and clinical reviews significantly faster than if they submitted requests by phone or fax. This integration through health care software company MCG Health gives our providers an efficient and effective alternative to archaic fax and phone processes. Today in the provider portal, you can attach medical records and other documents in support of preauthorization requests, concurrent reviews, and emergent inpatient admission and newborn notifications.
For our network facilities, they may only need to notify us that a member is in a bed so we can help their staff and the member prepare for discharge and post-acute care. These changes can also allow hospitals to accelerate the transfer of a patient needing home care or admission to a skilled nursing facility—especially during weekends. By speeding up the authorization process through our portal, hospital nursing staff will spend less time waiting for us and can focus on connecting our members to the post-acute care they need.
Free up time and staff for patient care
The real benefits come for providers who choose to give up fax and phone for our provider portal. While reviewing our regularly updated preauthorization lists online (EmblemHealth / ConnectiCare Commercial / ConnectiCare Medicare) is the fastest way to look up if a procedure requires a preauthorization, the provider portal is the fastest way to submit a request for a decision. If a preauthorization request is needed, providers can answer some questions and submit clinical information on the portal to get the review and approval process moving, saving significant time and effort. The portal will ask the same questions, and allow attaching the same clinical documents, that we would ask for if a provider faxed their initial request—but WITHOUT the delay that comes with having to follow up by phone.
Need more information?
We encourage you to review our Frequently Asked Questions (EmblemHealth | ConnectiCare) which further describe the rolling updates to both process and provider portal that we believe will deliver meaningful change to our network.
If providers need help navigating our provider portals, they can see our videos, quick guides, and portal Frequently Asked Questions here:
EmblemHealth Videos and User Guides EmblemHealth FAQs
ConnectiCare Videos and User Guides ConnectiCare FAQs
If providers still have questions or need additional support, they may contact Provider Customer Service:
EmblemHealth: 866-447-9717
ConnectiCare: Commercial: 860-674-5850, Medicare: 877-224-8230
It is important to note that this change to preauthorizations and clinical reviews only applies to procedures and diagnoses reviewed by EmblemHealth and ConnectiCare. We are continuing to talk with our delegated vendors about their preauthorization processes and whether similar changes can be made. We will share more information as it becomes available.
JP 62160 05/2023