![]() Hartford Healthcare, responding to an inquiry from CT by the Numbers, indicated that “in order to avoid disruption to our patients, Hartford HealthCare continues to provide care to these individuals as Anthem works to resolve the issues.” In a statement, Hartford Healthcare noted that they were “in contact with Anthem, and we are aware that Anthem is experiencing technical issues with its electronic system for verifying coverage for patients needing physical, speech or occupational therapy.”Īnthem did not respond to a request for comment, but at least some Anthem policy holders were told on Wednesday - with the July 4 holiday weekend just hours away - that Anthem had decided to suspend the pre-authorization requirement for PT and OT services for the remainder of July. By July 3, with complaints increasing, both Hartford Healthcare and Anthem determined that the situation was untenable. The result: physical therapy appointments were cancelled – as many as 6 or 7 a day in some locations – with uncertainty as to when the communication challenges might be resolved, and physical therapy services could be resumed, or begun, for those patients.Īnthem switched its preauthorization process to AIM in Connecticut as of July 1. Office personal at Hartford Healthcare locations across the state – and perhaps other physical therapy offices operated by others as well – could not gain access to the AIM system to input patient information in order to obtain the pre-authorization required by Anthem before an insured patient could see a physical therapist. It is quite apparent now that in the first days of this month, as it was to take over providing those services for Anthem in Connecticut, AIM did not come close to keeping up.Ĭonnecticut residents insured by Anthem utilizing the physical therapy services of Hartford Healthcare, among the state’s largest health care organizations, found that previously routine prior authorizations were impossible to obtain. Keep up.” Those words appear prominently on the website of AIM Specialty Health, a subsidiary of Anthem Blue Cross Blue Shield, and a provider of utilization management services, better known as the “pre-authorization” that medical providers require before agreeing to see patients with insurance coverage. Magellan (on behalf of NYRx, the Medicaid pharmacy program)Ĭall Provider Hotline: 88, Monday to Friday from 8 a.m. to 7 p.m., Monday through FridayĬall 88, option 6, 8 a.m. to 6 p.m.Ĭall 87, Monday through Friday, 8 a.m. Pharmacy Services (also see the Pharmacy Medical Preauthorization List)Ĭall 87, Monday through Friday, 8 a.m. Requests and supporting clinical information must be faxed to 84. Spine Surgery and Pain Management Therapy Programįor forms via by calling 84. ![]() (formerly GHI) members)Ĭhiropractic Services Outpatient Physical and Occupational Therapy (formerly GHI), submit requests: Online: /providersĬardiology and Radiology Services Durable Medical Equipment (DME)Ĩ0 (for EmblemHealth Plan, Inc. Online: /providersĬall Carelon Behavioral Health (formerly Beacon Health Options) atĮmblemHealth Behavioral Management Programįor members in plans underwritten by EmblemHealth Plan, Inc. To see what needs authorization, use their look-up tool.Įmblem Behavioral Health Services Programįor members in plans underwritten by HIP or EmblemHealth Insurance Company (formerly HIPIC), submit requests: ![]() Utilization management for GHI PPO City of New York employees and non-Medicare eligible retirees with GHI PPO benefits is managed by Empire BCBS for inpatient and outpatient services.įor fertility prescriptions and infertility services, including artificial insemination and IVF: (Applicable to Health Insurance Plan of Greater New York (HIP) only) Skilled Nursing Facility Inpatient Rehabilitation Facility Long-Term Care Facility Home Health Care (formerly GHI)):įor questions regarding the Preauthorization process or the status of a specific request, call Customer Service at See Additional Preauthorization Procedures for GHI Practitioners for more information. See additional contacts below.Īll HIP/EmblemHealth Insurance Company (formerly HIPIC) Plans:Ĭall 86 for more information or to use the IVR system.Ĭall the Coordinated Care Intake department at WHO TO CONTACT FOR PREAUTHORIZATIONĮmblemHealth has partnered with various companies to provide special utilization management programs. See Clinical Corner for services that require Preauthorization. All providers must verify member eligibility and benefits prior to rendering non-emergency services.
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