Emblemhealth provider modification

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Contact Us. EZ-Net Training. Demographic Change Request Form. Re-credentialing Package. View and download our Contact Aid to use in your office. If you have any questions, your provider representative is a great place to start. They are your primary contact and liaison between all of the departments at HCP. We have a number of teams within our quality department that can partner with you to ensure all patients receive the support they need to improve their health outcomes.

Administrative Support Services. Our team works hand-in-hand to support our main priorities — our providers and members. Start with Customer Service and we will direct you. Related Materials Contact your Provider Relations Specialist If you have any questions, your provider representative is a great place to start. Switch to: members brokers employers. Sign in Contact Us Search. Navigation Open. Switch to:.

Clinical Corner. Quality Improvement Find our Quality Improvement programs and resources here. Search Our Quality Improvement Page. Claims Corner. Reimbursement Policies Payment processes unique to our health plans Payment Integrity Policies How we pursue payment accuracy. Provider Manual. Provider Manual Find the specific content you are looking for from our extensive Provider Manual.

Search the Provider Manual. Dental Corner. Welcome Dental Providers Find a Dentist. You can: Review the information we have on file for you by going to your profile on our secure provider portal. If you have not registered for an account, there is a registration button on the sign-in page. With a portal account you can add or delete locations directly to your profile. Send us updates by sending a fax to our Provider Modifications Team at Change of Address and Contact Notification Providers must notify Medicaid of any change of address, telephone number, or other pertinent information within 15 days of the change.

How to Update Information : To update provider addresses and telephone information, providers must complete their designated Change of Address form. Both forms must be mailed to: eMedNY P.

Box Rensselaer, NY With respect to participation in Federal Employees Health Benefits FEHB , providers and facilities must have in place business processes to ensure the timely provision of provider directory information to EmblemHealth: when the provider or facility begins a network agreement with EmblemHealth, when the provider or facility terminates a network agreement with EmblemHealth, when there are material changes to the content of provider directory information, upon request by EmblemHealth and at any other time determined appropriate by the provider, facility or U.

Department of Health and Human Services. Find a doctor or medical office. Access the EmblemHealth Portal. Sign In. All Rights Reserved.

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Be sure to regularly check the Clinical Corner for the latest updates. This includes home health care, skilled nursing facilities, acute rehabilitation , and long-term acute care hospital admissions. Once we announce the start date, you will need to contact EmblemHealth to help arrange for PAC services and support. Note: eviCore will continue to handle durable medical equipment for EmblemHealth members. Upcoming webinars: To help you better understand how the insourcing of all PAC services and the Transitions of Care program affects the members in your care, we will host a series of informational webinars.

All sessions will be held via Microsoft Teams between. For the full list of session dates and times, visit emblemhealth. Attention home health care providers: Our provider portal has a Home Health Status report to give you a consolidated view of the preauthorization requests for the members under your care. See the quick guide and video on our Portal Training page in the Preauthorization section for instructions on how to create the Home Health Status report.

Additional support: We offer a Transitions of Care program to help members with complex care issues better manage their health after a hospital admission. Our team will work with the member to make sure they are educated about their condition, have needed resources, and get the right care to feel better. Program information is available to our members on the Live Well section of our member website.

Until the COVID State of Emergency ends, our Medicare members with plans that traditionally require referrals may continue to see specialists without referrals. When this changes, notice will be provided.

Please review so you know whether a member needs a referral to see a specialist. Visit our EmblemHealth Preauthorization Lists page to see what requires preauthorization and who is responsible for the utilization review.

Updates to the lists are posted in the Notable Changes section. The provider portal makes coordination of care easier. Spend less time on the phone and feeding documents into a fax machine. By using the portal instead of faxes, you help us get started on your reviews sooner since the requests are legible. Upload documentation while creating a preauthorization request or afterwards by going back into the same preauthorization request to supplement the request and to provide concurrent review information.

If you need help with these transactions or getting access to the portal, see these educational materials guides and videos and our Frequently Asked Questions webpage. EmblemHealth : See our Care Management Programs page for program descriptions, ways we can support you and your patients, and program-specific contact information.

If you need general assistance, you can call Monday through Friday from 9 a. Four Clinical Practice Guidelines were updated in To ensure public safety and track conditions affecting public health, the federal government, New York State, and New York City agencies have enacted laws that must be followed by health care professionals.

Our network practitioners are required to participate in government reporting procedures and adhere to all rules, regulations, and codes. For a list of government agencies with required reporting, read the Regulatory Mandatory Reporting chapter of our online Provider Manual.

Below, find the new and revised EmblemHealth medical policies published since December as well as those that have been retired. New Medical Policies. Revised Medical Policies. Retired Medical Policies. Our Medical Technologies Database is routinely reviewed to ensure it is current.

Dispositions apply to all lines of business unless otherwise indicated. This listing also captures annual procedure coding updates since December Many EmblemHealth and ConnectiCare members have plans which give them access to providers in both organizations. Check the Summary of Companies, Lines of Business, Networks, and Benefit Plans to see which plans and networks offer reciprocity and view details on primary care provider PCP and referral requirements, out-of-network coverage, copays, and maximum out-of-pocket limits.

Medical Policy Updates. At the top of the page, select Commercial or Medicare to see the applicable policies. Below, find the new and revised medical policies published since December , including a new policy starting January 1, :.

To bring more transparency to how we process claims, we introduced two new payment integrity policies :. Reimbursement Policies. Below is a summary of the substantive updates posted since December including a new policy that will go into effect in Retired Reimbursement Policies. Note: As of May 1, , Commercial and Medicare claims submitted with missing, invalid, or incomplete NDC or other information are being denied. Pulse8 offers free webinars for patient management and ICD coding. To register, go to pulse8.

See our Learning Online page for the full schedule. If you have questions or would like to set up a private session for your practice, please email ProviderEngagement Pulse8.

Their hours are Monday through Friday from 8 a. Learn more about the Pulse8 Collabor8 risk adjustment program. You can manage your learning, track credits online, and complete activities at your own pace. Our Find a Network Pharmacy tools can help you and your members find a nearby participating pharmacy. New Aug. Starting Aug. Routine maintenance will be covered in the following outpatient settings:.

We will allow exceptions for initial doses and members with justifiable needs to continue care in a hospital outpatient setting. Email Address: EmblemTreatments nycancer. For help finding an optimal infusion setting for your patient, email us at HomeInfusionteam emblemhealth.

For a list of frequently used phone numbers, addresses, and websites, see the Directory chapter of the EmblemHealth Provider Manual. You can save time by checking Provider Help and Support page's compilation of frequently asked questions and answers before contacting Customer Service.

Our provider portal is designed to be simple and intuitive. Should you need help, see these frequently asked questions, videos, and user guides to help you, step-by-step, through each transaction.

To add more information, go into the original preauthorization request and use the upload documentation feature. They will be able to view information, but not submit new transactions. This means portal administrators only need to actively update non-provider staff user accounts for those who should not have portal access. Find Them on Our Provider Portal. It has information about your administrative responsibilities, contractual and regulatory obligations, and best practices for helping members navigate our delivery systems.

Revisions are made as policies are renewed, new programs are introduced, and rules change. EmblemHealth Neighborhood Care provides in-person customer support, access to community resources, and programming to help the community learn healthy behaviors. Members and non-members alike can visit Neighborhood Care and take advantage of our classes, tools, and face-to-face support.

The health and wellness classes support the different dimensions of wellness, including physical, financial, social, and emotional. Neighborhood Care does not provide medical services. Instead, our role is to help practitioners manage patient care by supporting the practitioner-patient relationship.

The Provider Toolkit has guides and quick references to help with the administration of our plans. The Toolkit is where we house welcome materials for new providers. Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. Switch to: members brokers employers. Sign in Contact Us Search. You can find additional information on our Domestic Violence Guidelines page. To satisfy this requirement, providers must complete one of these two programs:.

OMH also offers a host of educational materials on its website for behavioral health providers. Materials can also be found on the CTAC website. The Claims Corner section of our provider website is part of the EmblemHealth Provider Manual and houses Administrative Guidelines described in our participation agreements. Be sure to check the Claims Corner section of our provider website frequently for the latest updates.

These pages have sortable and searchable tables to make information easier to find. As we add policies, we will remove or archive the old postings on the other Claims Corner pages as appropriate. We changed some policy titles to improve sorting results. We also introduced Archive sections to house information that has been replaced or only applies to a prior date of service. Payment Integrity Policies and Audits.

As of Aug. We contracted with Optum to perform these audits on our behalf. Notification via letters, their audit findings, and instructions on how to appeal their determinations are sent directly from Optum. As of Sept. Below is a summary of the substantive updates posted since December , including new policies that will go into effect in As of Oct. Using an incorrect code can result in denied claims. Federal law mandates that health care practitioners use their unique, digit NPI when submitting standard electronic health care transactions, such as claims.

The absence of taxonomy codes may result in incorrect payments or the inability of your patients to fill their prescription. EmblemHealth Risk Adjustment Program. To help you do this, Pulse8 offers free, minute monthly webinars that are followed by a question-and-answer period. We encourage you and your staff to participate. Learn more about Pulse8 and how it can help your practice. Also, you can learn more about the Pulse8 Collabor8 risk adjustment program by clicking on the link below:.

The EmblemHealth timely filing time frame is days from the date of service, unless EmblemHealth is the secondary payor or the participation agreement states an alternative time frame to be applied. See the EmblemHealth Provider Manua l for full policy. Through ECHO, you can receive direct deposits to your bank account s known as electronic funds transfer EFT and view or download your remittances online known as electronic remittance advantage ERA. Electronic transactions are fast, convenient, and reduce the risk of lost or stolen payments.

This solution is free and allows you to reduce payment processing costs and improve cash flow. The Clinical Corner section of the EmblemHealth provider website is part of the EmblemHealth Provider Manual and houses Administrative Guidelines described in our participation agreements.

This is where you will find preauthorization rules, medical policies, care management programs, special utilization management programs, pharmacy information - including formularies, behavioral health and dental information, and more. This is also where you will find current code lists and a Preauthorization Lookup tool. Be sure to regularly check the Clinical Corner section of our provider website for the latest updates. You can find all EmblemHealth Preauthorization Lists posted to our website.

Changes to the list will be posted to the Preauthorization Rules page, not the News page. Good news! Starting Jan. This is part of an ongoing evaluation of our preauthorization lists and an effort to simplify the administrative burden for our providers. Starting Feb. See the full list of CPT Codes and their descriptions on our websites:.

The new Provider Portal makes coordination of care easier. Spend less time on the phone and feeding documents into a fax machine. By using the portal instead of faxes, you help us get started on your reviews sooner since all the requests are legible. With the introduction of the new Provider Portal, providers are now able to upload supporting documentation while creating a preauthorization request or afterwards to supplement the request.

Providers are asked to only submit the request through the Provider Portal. If, however, a request is submitted over the phone or by fax, do not resend the same request through the portal. Only one request is needed. Referrals may be submitted up to 30 days after the date of service to support member access to care.

If you need help with these transactions or getting access to the portal, see these educational materials guides and videos , and our Frequently Asked Questions webpage. When this changes, notice will be provided. Please review so you know whether a member needs a referral to see a specialist. We provide condition-specific education to reinforce established treatment plans and ensure a thoughtful, member-centric experience to achieve their self-management goals.

We can also assist in navigation and coordination support to ensure our members can obtain the necessary care and resources in the right setting. No changes were made in HIV , and behavioral health issues.

To ensure public safety and to track conditions affecting public health, the federal government, New York State and New York City agencies have enacted laws that must be followed by health care professionals. Our network practitioners are required to participate in government reporting procedures and adhere to all rules, regulations, and codes. For a list of government agencies with required reporting, access the Regulatory Mandatory Reporting chapter of our online Provider Manual.

Additions and changes are noted after the policy name in the table. Soon, the Pharmacy Medical Policies are going to be moved to their own dedicated page in the Pharmacy section of Clinical Corner. Below, find the new and revised EmblemHealth medical policies published since December Our Medical Technologies Database is routinely reviewed to ensure it is current.

Dispositions apply to all lines of business unless otherwise indicated. This listing also captures annual procedure coding updates since December Many EmblemHealth and ConnectiCare members have plans which give them access to providers in both organizations. See the Summary of Companies, Lines of Business, Networks, and Benefit Plans to see which plans and networks offer reciprocity, details on PCP and referral requirements, out-of-network coverage, copays, and maximum out-of-pocket limits.

These members will not have access to EmblemHealth providers. Headlines You May Have Missed. Medical Policy Updates. At the top of the page, select Commercial or Medicare to see the applicable policies. Below, find the new and revised medical policies published since December We routinely evaluate claims for coding, billing accuracy, and appropriateness.

Providers are required to supply requested supporting information such as itemized bills and medical records. Note: Neither additional records nor amended records will be accepted once an audit review is complete.

In addition, we added outpatient APC audits to our payment integrity correct coding evaluations effective Aug. We are contracted with Optum to perform these audits on our behalf.

Notification via letters, their audit findings, and instructions on how to appeal their determinations will be coming directly from Optum. Reimbursement Policies. Below is a summary of the substantive updates posted since December including new policies that will go into effect in Pulse8 offers free webinars for patient management and ICD coding.

To register, go to pulse8. See the full schedule for If you have questions, or would like to set up a private session for your practice, please email ProviderEngagement Pulse8. Their hours are 8 a. Learn more about the Pulse8 Collabor8 risk adjustment program. You can manage your learning, track credits online, and complete activities at your own pace.

On Oct. See the Pharmacy Balance Billing guide for instructions. Our Express Scripts, Inc. Preferred pharmacies help members save on prescription drugs and improve medication adherence, so we ask that you remind members to use a preferred pharmacy when you can. Standard pharmacies that participate in the Preferred Value Network but only offer standard cost-sharing include:.

Pharmacy locator links are available on our website to help you and your members find a nearby participating pharmacy. Pharmacy Taking medications as prescribed medication adherence is important for treating and controlling chronic conditions.

Doctors play an important role in helping members stay adherent. Here are some steps as a doctor you can take to help members remain adherent:. Please help your members stay adherent and save on their prescription drugs by recommending members switch to preferred mail order:. Both Federal and State laws protect dual eligibles from being balance billed. For more information about coordinating benefits with Medicaid for pharmacy providers, see the Pharmacy Balance Billing guide for instructions.

For a list of frequently used phone numbers, addresses, and websites, see the Directory Chapter of the EmblemHealth Provider Manual. You can save time by checking Provider Help and Support page's compilation of frequently asked questions and answers before contacting Customer Service. Provider Portal. Take advantage of our new provider portal.

You can check member eligibility and benefits, review claims status, update your practice information, create a referral, request preauthorization, and more. Plus, no more signing in and out of our sites.

You can now see information and process transactions for all of our members with one User ID! Our new Provider Portal is designed to be simple and intuitive. Should you need help, see the How do I use the Provider Portal? Tab of the Provider Help and Support page for key things you should know. If you first need to set up an account, or have a question about a transaction, see our provider portal frequently asked questions webpage to address the most common issues our Provider Customer Service team has been receiving.

To help you with the online transactions, we have posted a series of videos and user guides to help you step by step through each one. The online Provider Manual is an extension of your contract with us. It has information about your administrative responsibilities, contractual and regulatory obligations, and best practices for helping members navigate our delivery systems.

Revisions are made as policies are renewed, new programs are introduced, and rules change. EmblemHealth Neighborhood Care. EmblemHealth Neighborhood Care provides in-person customer support, access to community resources, and programming to help the community learn healthy behaviors.

Members and non-members alike can visit Neighborhood Care and take advantage of our classes, tools, and face-to-face support. The health and wellness classes support the different dimensions of wellness, including physical, financial, social, and emotional. Neighborhood Care does not provide medical services. Instead, our role is to help practitioners manage patient care by supporting the practitioner-patient relationship.

Member Materials. The Provider Toolkit has guides and quick references to help with the administration of our plans. The Toolkit is where we house Welcome materials for new providers. Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider.

If you have any concerns about your health, please contact your health care provider's office.

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All sessions will be held via Microsoft Teams between. For the full list of session dates and times, visit emblemhealth. Attention home health care providers: Our provider portal has a Home Health Status report to give you a consolidated view of the preauthorization requests for the members under your care.

See the quick guide and video on our Portal Training page in the Preauthorization section for instructions on how to create the Home Health Status report. Additional support: We offer a Transitions of Care program to help members with complex care issues better manage their health after a hospital admission.

Our team will work with the member to make sure they are educated about their condition, have needed resources, and get the right care to feel better. Program information is available to our members on the Live Well section of our member website. Until the COVID State of Emergency ends, our Medicare members with plans that traditionally require referrals may continue to see specialists without referrals.

When this changes, notice will be provided. Please review so you know whether a member needs a referral to see a specialist. Visit our EmblemHealth Preauthorization Lists page to see what requires preauthorization and who is responsible for the utilization review.

Updates to the lists are posted in the Notable Changes section. The provider portal makes coordination of care easier. Spend less time on the phone and feeding documents into a fax machine. By using the portal instead of faxes, you help us get started on your reviews sooner since the requests are legible.

Upload documentation while creating a preauthorization request or afterwards by going back into the same preauthorization request to supplement the request and to provide concurrent review information.

If you need help with these transactions or getting access to the portal, see these educational materials guides and videos and our Frequently Asked Questions webpage.

EmblemHealth : See our Care Management Programs page for program descriptions, ways we can support you and your patients, and program-specific contact information. If you need general assistance, you can call Monday through Friday from 9 a. Four Clinical Practice Guidelines were updated in To ensure public safety and track conditions affecting public health, the federal government, New York State, and New York City agencies have enacted laws that must be followed by health care professionals.

Our network practitioners are required to participate in government reporting procedures and adhere to all rules, regulations, and codes. For a list of government agencies with required reporting, read the Regulatory Mandatory Reporting chapter of our online Provider Manual. Below, find the new and revised EmblemHealth medical policies published since December as well as those that have been retired.

New Medical Policies. Revised Medical Policies. Retired Medical Policies. Our Medical Technologies Database is routinely reviewed to ensure it is current. Dispositions apply to all lines of business unless otherwise indicated. This listing also captures annual procedure coding updates since December Many EmblemHealth and ConnectiCare members have plans which give them access to providers in both organizations.

Check the Summary of Companies, Lines of Business, Networks, and Benefit Plans to see which plans and networks offer reciprocity and view details on primary care provider PCP and referral requirements, out-of-network coverage, copays, and maximum out-of-pocket limits. Medical Policy Updates. At the top of the page, select Commercial or Medicare to see the applicable policies. Below, find the new and revised medical policies published since December , including a new policy starting January 1, :.

To bring more transparency to how we process claims, we introduced two new payment integrity policies :. Reimbursement Policies.

Below is a summary of the substantive updates posted since December including a new policy that will go into effect in Retired Reimbursement Policies. Note: As of May 1, , Commercial and Medicare claims submitted with missing, invalid, or incomplete NDC or other information are being denied. Pulse8 offers free webinars for patient management and ICD coding. To register, go to pulse8.

See our Learning Online page for the full schedule. If you have questions or would like to set up a private session for your practice, please email ProviderEngagement Pulse8. Their hours are Monday through Friday from 8 a.

Learn more about the Pulse8 Collabor8 risk adjustment program. You can manage your learning, track credits online, and complete activities at your own pace. Our Find a Network Pharmacy tools can help you and your members find a nearby participating pharmacy. New Aug. Starting Aug. Routine maintenance will be covered in the following outpatient settings:. We will allow exceptions for initial doses and members with justifiable needs to continue care in a hospital outpatient setting.

Email Address: EmblemTreatments nycancer. For help finding an optimal infusion setting for your patient, email us at HomeInfusionteam emblemhealth. For a list of frequently used phone numbers, addresses, and websites, see the Directory chapter of the EmblemHealth Provider Manual. You can save time by checking Provider Help and Support page's compilation of frequently asked questions and answers before contacting Customer Service. Our provider portal is designed to be simple and intuitive.

Should you need help, see these frequently asked questions, videos, and user guides to help you, step-by-step, through each transaction.

To add more information, go into the original preauthorization request and use the upload documentation feature. They will be able to view information, but not submit new transactions. This means portal administrators only need to actively update non-provider staff user accounts for those who should not have portal access. Find Them on Our Provider Portal. It has information about your administrative responsibilities, contractual and regulatory obligations, and best practices for helping members navigate our delivery systems.

Revisions are made as policies are renewed, new programs are introduced, and rules change. EmblemHealth Neighborhood Care provides in-person customer support, access to community resources, and programming to help the community learn healthy behaviors. Members and non-members alike can visit Neighborhood Care and take advantage of our classes, tools, and face-to-face support. The health and wellness classes support the different dimensions of wellness, including physical, financial, social, and emotional.

Neighborhood Care does not provide medical services. Instead, our role is to help practitioners manage patient care by supporting the practitioner-patient relationship. The Provider Toolkit has guides and quick references to help with the administration of our plans. The Toolkit is where we house welcome materials for new providers. Any information provided on this Website is for informational purposes only.

It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan.

Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. Switch to: members brokers employers. Sign in Contact Us Search. Navigation Open. Switch to:. Clinical Corner. Quality Improvement Find our Quality Improvement programs and resources here. Search Our Quality Improvement Page. No changes were made in HIV , and behavioral health issues. To ensure public safety and to track conditions affecting public health, the federal government, New York State and New York City agencies have enacted laws that must be followed by health care professionals.

Our network practitioners are required to participate in government reporting procedures and adhere to all rules, regulations, and codes. For a list of government agencies with required reporting, access the Regulatory Mandatory Reporting chapter of our online Provider Manual.

Additions and changes are noted after the policy name in the table. Soon, the Pharmacy Medical Policies are going to be moved to their own dedicated page in the Pharmacy section of Clinical Corner. Below, find the new and revised EmblemHealth medical policies published since December Our Medical Technologies Database is routinely reviewed to ensure it is current.

Dispositions apply to all lines of business unless otherwise indicated. This listing also captures annual procedure coding updates since December Many EmblemHealth and ConnectiCare members have plans which give them access to providers in both organizations.

See the Summary of Companies, Lines of Business, Networks, and Benefit Plans to see which plans and networks offer reciprocity, details on PCP and referral requirements, out-of-network coverage, copays, and maximum out-of-pocket limits. These members will not have access to EmblemHealth providers. Headlines You May Have Missed. Medical Policy Updates. At the top of the page, select Commercial or Medicare to see the applicable policies. Below, find the new and revised medical policies published since December We routinely evaluate claims for coding, billing accuracy, and appropriateness.

Providers are required to supply requested supporting information such as itemized bills and medical records. Note: Neither additional records nor amended records will be accepted once an audit review is complete. In addition, we added outpatient APC audits to our payment integrity correct coding evaluations effective Aug.

We are contracted with Optum to perform these audits on our behalf. Notification via letters, their audit findings, and instructions on how to appeal their determinations will be coming directly from Optum. Reimbursement Policies. Below is a summary of the substantive updates posted since December including new policies that will go into effect in Pulse8 offers free webinars for patient management and ICD coding.

To register, go to pulse8. See the full schedule for If you have questions, or would like to set up a private session for your practice, please email ProviderEngagement Pulse8.

Their hours are 8 a. Learn more about the Pulse8 Collabor8 risk adjustment program. You can manage your learning, track credits online, and complete activities at your own pace. On Oct. See the Pharmacy Balance Billing guide for instructions. Our Express Scripts, Inc. Preferred pharmacies help members save on prescription drugs and improve medication adherence, so we ask that you remind members to use a preferred pharmacy when you can. Standard pharmacies that participate in the Preferred Value Network but only offer standard cost-sharing include:.

Pharmacy locator links are available on our website to help you and your members find a nearby participating pharmacy. Pharmacy Taking medications as prescribed medication adherence is important for treating and controlling chronic conditions. Doctors play an important role in helping members stay adherent. Here are some steps as a doctor you can take to help members remain adherent:.

Please help your members stay adherent and save on their prescription drugs by recommending members switch to preferred mail order:. Both Federal and State laws protect dual eligibles from being balance billed. For more information about coordinating benefits with Medicaid for pharmacy providers, see the Pharmacy Balance Billing guide for instructions. For a list of frequently used phone numbers, addresses, and websites, see the Directory Chapter of the EmblemHealth Provider Manual.

You can save time by checking Provider Help and Support page's compilation of frequently asked questions and answers before contacting Customer Service. Provider Portal. Take advantage of our new provider portal.

You can check member eligibility and benefits, review claims status, update your practice information, create a referral, request preauthorization, and more. Plus, no more signing in and out of our sites. You can now see information and process transactions for all of our members with one User ID!

Our new Provider Portal is designed to be simple and intuitive. Should you need help, see the How do I use the Provider Portal? Tab of the Provider Help and Support page for key things you should know. If you first need to set up an account, or have a question about a transaction, see our provider portal frequently asked questions webpage to address the most common issues our Provider Customer Service team has been receiving.

To help you with the online transactions, we have posted a series of videos and user guides to help you step by step through each one. The online Provider Manual is an extension of your contract with us. It has information about your administrative responsibilities, contractual and regulatory obligations, and best practices for helping members navigate our delivery systems. Revisions are made as policies are renewed, new programs are introduced, and rules change.

EmblemHealth Neighborhood Care. EmblemHealth Neighborhood Care provides in-person customer support, access to community resources, and programming to help the community learn healthy behaviors.

Members and non-members alike can visit Neighborhood Care and take advantage of our classes, tools, and face-to-face support. The health and wellness classes support the different dimensions of wellness, including physical, financial, social, and emotional.

Neighborhood Care does not provide medical services. Instead, our role is to help practitioners manage patient care by supporting the practitioner-patient relationship.

Member Materials. The Provider Toolkit has guides and quick references to help with the administration of our plans. The Toolkit is where we house Welcome materials for new providers. Any information provided on this Website is for informational purposes only.

It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. Switch to: members brokers employers. Sign in Contact Us Search. Navigation Open.

Switch to:. Clinical Corner. Quality Improvement Find our Quality Improvement programs and resources here. Search Our Quality Improvement Page. Claims Corner. Reimbursement Policies Payment processes unique to our health plans Payment Integrity Policies How we pursue payment accuracy. Provider Manual. Provider Manual Find the specific content you are looking for from our extensive Provider Manual.

Search the Provider Manual. Dental Corner. Welcome Dental Providers Find a Dentist. Home Annual Provider Notification. The links now go to permanent webpages where you will be able to find product-specific information all year long: Bridge Program Note: Providers who are only contracted with EmblemHealth Plan, Inc. Members should not be turned away. These surveys ask about getting appointments and care quickly, ease of getting needed care, ease of communicating with staff and doctors, getting help in coordinating care, flu vaccination, and the overall experience of getting care.

Positive experiences result in better survey ratings. The sections below include tips for improving the patient experience which you can apply in your practices. Here are some non-clinical tips to boost your measurement scores: When billing, use the correct codes which relate to ALL services given during the visit. This may reduce chart collection.

Help your patients get care quickly: Leave open appointments for sick visits and urgent appointments. Ensure patients understand timeline for follow-up. Discuss how to access care after hours. Assist your patients with getting the care they need: Educate your patients on the importance of preventive services.

Follow-up with specialists of patients to ensure continuity of care. Ask patients what their top health concerns are. Use the teach-back method to ensure understanding.

Care Coordination: Assist in coordination of non-emergency transportation, if necessary. Link patients with community resources to facilitate referrals and respond to social service needs.

Collaboration is KEY! Collaborative activities EmblemHealth continually conducts activities to improve behavioral health and general medical care, including collaboration with behavioral health practitioners.

Implement primary care guidelines for assessing, treating, and referring common behavioral problems. Increase non-behavioral health care practitioner satisfaction with feedback from behavioral health care practitioners. Improve procedures for treating hospitalized members with coexisting medical and behavioral health conditions. Improve management of elderly members with indications of depression and multiple behavioral health care medications. Educate primary care practitioners about appropriate indications for referring patients with hyperactivity disorder, substance use disorders, or depression to behavioral health care specialists.

Implement a prevention program for behavioral disorders commonly managed in the primary care setting. Appropriate diagnosis, treatment, and referral of behavioral health disorders commonly seen in primary care. Appropriate use of psychotropic medications.

Oversight of access to treatment and proactive follow-up for members with coexisting medical and behavioral disorders. Preventive behavioral health care program implementation in both primary and secondary settings. Accommodations to be made for the special needs of our members with severe and persistent mental illness.

Confidentiality for domestic violence or endangered victims Please let your affected patients know they are entitled to these privacy protections: Group policy members may ask us to enforce an order of protection against the policyholder or other person. We will not disclose their address or telephone number for the duration of the order. We will accommodate any reasonable request for a covered individual to receive communications of claim-related information by an alternative means or at an alternative location.

To satisfy this requirement, providers must complete one of these two programs: OASAS-approved training. Two Uniform Network Provider Training modules. More educational materials OMH also offers a host of educational materials on its website for behavioral health providers. Claims Corner The Claims Corner section of our provider website is part of the EmblemHealth Provider Manual and houses Administrative Guidelines described in our participation agreements.

Timely Filing Reminder The EmblemHealth timely filing time frame is days from the date of service, unless EmblemHealth is the secondary payor or the participation agreement states an alternative time frame to be applied.