EmblemHealth

Effective April 30, 2025, pre-authorization requests on behalf of OrthoNet will be redirected to the Optum One Healthcare ID (OHID) registration page. Please use the appropriate link below to log in or register with One Healthcare ID.

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

    Prior Authorization Submission
    and
    Status
    To begin using our secure site; you must create a user account.
  • New User-Account Request Form

    • To submit authorization check status
  • Request Authorization or Check Status

    • Click on the Web Portal FAQ for Step by Step directions.

    Contact
    Medical Management
    844-730-8503
    Fax: 844-296-4440

    Health Plan Web Sites
    www.emblemhealth.com