Medical Provider Newsletter - May 2020

Updates to EMI Health preauthorization guidelines effective 07/01/2020

Benefit preauthorization is required for certain services as part of EMI Health's commitment to help ensure our members get the most appropriate care, at the appropriate time, in the appropriate setting and to help avoid unpleasant surprises for providers and members at the time claims are processed. EMI Health continually monitors procedures requiring preauthorization and makes adjustments as necessary.

Effective 07/01/2020, all major diagnostic tests

Major diagnostic teting is interpreted according to generally accepted medical practice and definitions. Major diagnostic tests include, but may not be limited to, CT scans, PET scans, MRIs, and NMR.

The preauthorization process begins with a review for medical necessity. After medical necessity is determined through the Utilization Review and Case Management Unit, EMI Health finalizes the authorization by verifying patient eligibility, plan exclusions, COB information, plan maximums, etc. Upon completion, an authorization number is assigned, and a letter is sent to both the provider and the member. For more information regarding EMI Health's preauthorization process, including details on how to submit your preauthorization request, visit our website or contact our preauthorization department at 801-270-3037 or 888-223-6866.

We appreciate the service you provide to our members. If you have any questions about this notice, or if there is anything we can do for you, please contact your provider relations representative.