To get you our decisions faster, we are phasing in the delivery of our determination letters for preauthorization requests and initial and continued stay concurrent reviews (determination letters) through the provider portal. EmblemHealth’s New York commercial members (including members in self-funded, administrative services only (ASO) groups) have been prioritized so we can meet New York State’s mandate to deliver determination letters to members and providers electronically. We are striving to do the same for our EmblemHealth Medicaid, HARP, Child Health Plus, and Essential Plan members by the end of the year. This will be followed by delivering all determination letters through the provider portal for all EmblemHealth and ConnectiCare members in 2024. The training guides are being updated and will be available soon.
Where letters are in the portal
A new section, “UM Letters” has been added to the Preauthorization Details page for EmblemHealth’s New York commercial members.
Who can see the letters
Everyone who can see the preauthorization request will be able to see the letters including the requesting and servicing clinicians, the facility, and their authorized users.
Email notifications
The person making the preauthorization request, or their designee, will receive an email letting them know the determination letter has been posted. Going forward, electronic delivery of the notification will be the default option. This will allow us to expedite delivery of the determination letters days faster than the US Postal Service.
JP 62865 08/2023