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Update: Delay in Portal Transition for Back Pain and Spinal Surgery Authorizations
The planned transition to Optum's Spine, Pain, and Joint portal for prior authorization submissions-originally scheduled
for September 3, 2025-has been postponed. Portal users will be notified of the new go-live date and details at least 30 days in advance. Please continue
using the OrthoNet portal for all back pain management and spinal surgery prior authorizations, until further notice.
Reminder: If you haven't already, we encourage you to register for a One Healthcare ID (OHID) to prepare for the future transition.
EmblemHealth has delegated utilization management for select spine surgery and interventional pain management therapy procedures to OrthoNet.
The Program requires that the treating clinician obtain prior approval for spine surgery and interventional pain management procedures defined by a list of CPT/ICD codes.
For a full list of spine surgery and interventional pain management therapy codes that require prior approval please visit emblemhealth.com. As with all utilization management programs,
this Program will determine if the proposed service meets the definition of medical necessity under the member's benefit plan.
This program applies to services, provided by practitioners, either in:
Practitioner's Office (POS 11)
Inpatient Hospital Setting (POS 21)
Outpatient Hospital Setting (POS 22)
Ambulatory Surgery Center (POS 24)
The Program includes members from the following EmblemHealth provider networks:
*HIP members assigned to a Montefiore CMO, St Barnabas or HealthCare Partners primary care practitioner (PCP) are excluded from this Program (Members can be identified by the Montefiore
or HCP logos on the ID card and on the Member Details page of the Eligibility/Benefits lookup feature on emblemhealth.com.
Clinical Criteria used for Pain and Spine Utilization Management
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