All hospital-based services, both inpatient and outpatient, require Prior Authorization to be obtained before the service can be covered unless the service is delivered in an emergency setting.
Emergent inpatient admissions
Submit a Notice of Admission within 24 hours of each emergent inpatient admission via FAX to (516) 515-8808.
Submit clinical documentation justifying the admission upon receipt of the request for such information (and all clinical updates) via FAX to (516) 515-8840.
Elective inpatient admissions and all outpatient hospital-based service requests require pre-service Prior Authorization, as do requests for:
- Long Term Acute Care Hospital admissions
- Inpatient Hospice Admissions.
These Prior Authorization requests should be submitted by sending a completed request form via FAX to (888) 746-6433 or (516) 746-6433.
Pre-service requests for the following services should be submitted via FAX to (516) 515-8860.
- Skilled Nursing Facility/Subacute Rehabilitation admissions
- Acute Rehabilitation Facility admissions
Inpatient Behavioral Health admissions
- Inpatient Behavioral Health admissions for EmpireBCBS Medicare patients require Prior Authorization from HCP and can be submitted in the same manner as described above.
Inpatient Behavioral Health Admissions for all EmblemHealth patients are managed by Beacon Health Options.