#priorauthorization – KR2 Medical Billing

#reimbursement, HealthFirst, NY Providers, Prior Authorization Insurance Carrier Updates

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

Posted on December 28, 2025 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.

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

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

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

Posted on December 28, 2025 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.

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

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

Posted on December 13, 2025 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: