EmblemHealth Updates: Pharmacy Utilization Management, New Member IDs, and Name Changes for HIP and GHI
Pharmacy Utilization Management
Beginning Jan. 1, 2021, Express Scripts will manage preauthorizations for EmblemHealth Medicare and Medicaid members’ pharmacy needs. The one exception is New Century Health (NCH), which will authorize most oncology-related chemotherapeutic drugs and supportive agents when delivered in the physician’s office, outpatient hospital, or ambulatory setting. Exceptions apply. Learn more.
Reminder: New Member IDs
To comply with Medicare regulations, EmblemHealth is issuing new IDs and new ID cards to Medicare subscribers’ dependents. The new IDs will be unique to each member and will not be a derivation of the subscriber’s ID. Your practice should always ask to see ID cards at each visit to ensure you have the most current information for online transactions, claims submissions, and referral requirements.
HIP and GHI
The names of GHI and HIPIC are changing to EmblemHealth Plan, Inc. and EmblemHealth Insurance Company, respectively.
