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Medical Provider Newsletter

June 2023 Newsletter

Introducing Procedure Code Look-Up

Streamline Preauthorization and Save Time

We are excited to introduce you to a valuable tool that can streamline the preauthorization process and save you time and effort: Procedure Code Lookup. Understanding which medical procedures require preauthorization can be a complex task, but with this handy resource, you can quickly determine if a preauthorization or medical necessity review is necessary for a particular procedure.


What is Procedure Code Lookup?


Procedure Code Lookup is a search tool that allows healthcare providers like you to easily identify whether a specific medical procedure or service requires preauthorization. By entering the relevant procedure code into the lookup system, you can swiftly access information regarding preauthorization requirements and medical necessity reviews.


How Does Procedure Code Lookup Benefit You?


1. Efficiency: Instead of manually searching through extensive documentation or contacting EMI Health for each procedure, Procedure Code Lookup provides instant access to preauthorization requirements. This saves you valuable time and effort.


2. Accuracy: By relying on a dedicated lookup system, you can be confident that you are obtaining up-to-date and accurate information about preauthorization requirements. This minimizes the risk of errors and ensures you provide the best possible care to your patients.


3. Simplified Workflow: Having easy access to preauthorization requirements allows you to integrate the process seamlessly into your existing workflow. You can promptly determine if preauthorization is required before proceeding with a procedure, reducing the potential for claim denials or delays.


How to Use Procedure Code Lookup:


Using Procedure Code Lookup is straightforward. Simply follow these steps:


1. Gather the procedure code(s) associated with what you would like to verify for preauthorization.


2. Access the Procedure Code Lookup tool by using this link: https://emihealth.com/Providers/ProcedureLookup


3. Select the PPO network and then enter the procedure code(s) into the search field and initiate the search.


4. Review the results to determine if preauthorization or a medical necessity review is required for the specific procedure(s) and any additional details provided.


5. Based on the results, take the necessary steps to initiate preauthorization, ensuring a smooth and seamless process for both you and your patients.


Remember, obtaining preauthorization is crucial for ensuring the medical necessity and coverage of procedures. By utilizing Procedure Code Lookup, you can simplify this process and focus more on providing high-quality care to your patients.


Important note

Preauthorization is not a guarantee of payment. Payment for preauthorized services and/or prescriptions is contingent upon eligibility and benefits at the time of service. All terms and provisions of the plan will apply, and any services and/or prescriptions in connection with a preauthorization approval that are exclusions or limited benefits will be reimbursed accordingly. Services and/or prescriptions that are exclusions of the policy will be denied; services that have plan limitations will be paid according to those limitations.


For more information, or if you have questions, contact our provider assistance team at 801-262-7975 or toll free at 800-644-5411.