Author: KR2Medical Billing

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC), AAPV Approved Instructor; and an owner of KR2 Medical Billing. I create educational material including blogs, presentations that focus on topics of medical billing, medical coding and reimbursement in healthcare.
Posted in #reimbursement, HealthFirst, NY Providers, Prior Authorization Insurance Carrier Updates

Healthfirst removes some procedures off the prior auth list (2026)

Posted on by KR2Medical Billing

For any DOS on Jan 1, 2026 and there after, Healthfirst will remove prior auth requirenment from the EviCore prior auth list.

Image via Healthfirst website

Please remember that member benefits (coverage vs non coverage) still applies.

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Posted in #reimbursement, EmblemHealth NY, Payer Updates, Prior Authorization Insurance Carrier Updates, Training

Emblem Health to add more DME codes to prior auth list.

Posted on by KR2Medical Billing

Are you a a DME provider or a physician that prescribes DME for Emblem Health members? Then this blog post is for you!

Starting on for any DOS 13,2026 and thereafter the following DME codes will be added to the prior authorization list.

Image via Emblem Health
Images via Emblem Health website

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Posted in #Medicareadvantage, #unitedhealthcare, NY Providers, Prior Authorization Insurance Carrier Updates

UHC to remove prior auth for some radiology and cardiology tests.

Posted on by KR2Medical Billing

Starting Jan 1, 2026 certain nuclear imaging tests, OBGYN ultrasounds, and certain cardiology tests will no longer require a prior authorization for some of the  following plan types:

1.UnitedHealthcare Insurance Company
2.UnitedHealthcare Mid-Atlantic, inc. 
3.UnitedHealthcare Plan of the River Valley, Inc. and 4.UnitedHealthcare Insurance Company of the River Valley
5.Oxford Health Insurance, Inc.
United Healthcare Level Funded (formerly All Savers Life Insurance Company of California)
6.Neighborhood Health Partnership, Inc.
7.UnitedHealthcare Individual Exchange plans, also referred to as UnitedHealthcare Individual and Family ACA Marketplace plans
8.UnitedHealthcare Services, Inc.
9.UnitedHealthcare Community Plans

Some of the affected codes are:

Image via UHC website

For a full list of affected codes please click here: https://www.uhcprovider.com/en/resource-library/news/2025/removal-prior-auth-radiology-cardiology.html

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