Medical Provider Newsletter
February 2022
Preauthorization update
Medical services preauthorization
We are pleased to announce that we have completed the transition of our medical review and care management services to American Health Holding. This includes the medical necessity portion of preauthorization requests. With this move, providers may now request preauthorization of medical services using the convenient, secure online certification portal.*
As an added convenience, providers may look up procedure codes on our website to see whether preauthorization or medical necessity review is required.
*This does not apply to Cigna providers located outside of Utah. If an EMI Health member is accessing your services through the Cigna network, Cigna will continue to conduct the utilization management for that member, and you may call EMI Health at 888-223-6866 to initiate a preauthorization.
Durable medical equipment
For durable medical equipment or prostheses preauthorization, submit a written request, accompanied by a letter of medical necessity to Preauthorization Department, EMI Health, 5101 South Commerce Drive, Murray, Utah 84107.
Prescription drug preauthorization
To initiate a preauthorization for a prescription drug, the prescriber may use one of the following methods:
- Call EMI Health at 800-662-5851.
- Fax medical records to EMI Health, Attention: Pharmacy Review, at 801-269-9734.
- Use an online prior-authorization vendor, such as Cover My Meds.
Timeframes for preauthorization
Most non-urgent preauthorizations are completed within seven business days from receipt of the request, but may take up to 15 days. If an extension is required beyond 15 days, we will notify you and the member of that need during the initial 15-day period.
Urgent preauthorizations are completed within 72 hours of the receipt of a complete request. Notice may be given orally, with a written or electronic notice provided within three days of the oral notice. As a reminder, urgent requests are for services that have not yet been provided and for which waiting 15 days could seriously jeopardize the patient's life, health, or ability to regain maximum function or would subject the patient to severe pain that cannot be adequately managed without the care or treatment being requested.
Questions?
For additional information or assistance with a preauthorization request, contact our Provider Assist team at cs@emihealth.com or 800-644-5411