05/14/2020
HIP/Emblem Waiving Requirement for In-Network PCP Referrals due to COVID-19
Has HIP/Emblem waived their requirement for in-network referrals from PCPs for specialist care due to the pandemic? We are hearing from patients and some PCP offices that this is the case, but I'm unable to find this information on the Emblem website. Thank you.
While the state has has relaxed some guidelines, referrals and some authorizations from the patient?s PCP or from utilization management are still in place during the COVID pandemic. Any specialist referrals or out of network authorizations for non-emergent, acute care are still in place with all insurances. Below are the guidelines that have been relaxed by the state:
- Authorizations for scheduled surgery or hospital admissions
- Concurrent review of inpatient hospital services
- Retrospective Review for Inpatient Hospital Services and Emergency Services at In-Network Hospitals and Payment of Claims
- Hospital Discharge Planning and Preauthorization for Home Health Care and Inpatient Rehabilitation Services Following an Inpatient Hospital Stay
- Hospital Discharge Planning and Preauthorization for Inpatient Substance Use Disorder Treatment and Inpatient Mental Health Services
- Notification Requirements for Emergency Hospital Admissions
- Internal and External Appeal Timeframes for Hospitals
- Issuer Audits of Hospital Payments and Overpayment Recovery
Below are additional links from Emblem Health and the DOH to supplement and provide additional details regarding the temporary lift in restrictions due to the pandemic: