LATE SUMMER 2013

 

Discover the New Features of Our Improved Provider Manual

GHI HMO Plans Now Underwritten By HIP

State Sponsored Programs Rebranded

Changes to Medicare PPO Prior Approval Rules for PT/OT/ST

Medicaid Redesign Team Updates

Claims Corner

Behind the Scenes

Case Management Programs

EmblemHealth Pharmaceutical Management Program

Changes to Provider Attestation Form Submission

High Risk Medications for Elderly Patients

Do You Make Snap Decisions?

Does Your Office Have a Flu Immunization Champion?

Serology Testing Inappropriate for Detection of Active H. pylori Infection

Correct Billing for Mammography Services

CPT Codes for Tobacco Cessation Counseling

Healthy Beginnings PATH

Clinical Corner

News&Notes Archive

  

Review your information now to ensure you are correctly listed in our EmblemHealth directories. If any of your information has changed or is inaccurate, just follow our simple instructions to update your profile online. Can't update your information online? Fax your changes to our Provider Modifications team at 1-877-889-9061.


Case Management Programs

On a focused, time-limited basis, case managers assess, plan, implement, coordinate, monitor and evaluate treatment and support services to meet the medical, behavioral and high-risk maternal health care needs of identified members. Case managers or social workers educate members about their health conditions, coordinate health care services and serve as an advocate and liaison between members, their families or caregivers, physicians and other clinical staff on the health care team.

EmblemHealth case managers or social workers collaborate with primary care physicians, mental health professionals and high-risk obstetricians to ensure that each memberís complex and often competing medical needs are addressed and that care solutions are implemented. The Complex Case Management program assists medical professionals in meeting the needs of our members with acute, chronic and disabling conditions such as:

  • Transplants (solid organ and bone marrow)
  • HIV/AIDS
  • Compromised neonates
  • Psychiatric and substance abuse (particularly those cases with significant psychiatric history)
  • High-risk maternity
  • Traumatic or catastrophic events

Care that supports your care plan
EmblemHealth's Complex Case Management program is a patient-centric approach to managing your patients' health care and service needs. Whether your patients have a relatively simple recovery, or one complicated by multiple chronic conditions, our complex case management team uses a multidisciplinary approach to support your patients and collaborate with you. Our complex case management team works with you and your patients to promote access to quality health care across the continuum and to ensure maximum health outcomes are achieved through individualized plans of care.

There is no additional cost for the case management services offered through our Complex Case Management program. Case management is voluntary and is a value-added program for your patients who meet eligibility requirements.

Learn more about our case management programs and the criteria for enrolling patients into the programs, by consulting the Provider Manual.

To refer a patient to the EmblemHealth Complex Case Management program, you may call 1-800-447-0768 or the phone number on the back of the member's ID card. To refer a high-risk maternity patient to the Healthy Beginnings PATH Pregnancy Management program, you may call 1-888-447-0337.

Please refer a patient with psychiatric and/or substance abuse issues to the appropriate behavioral health team:

  • For plans underwritten by GHI, call ValueOptions at 1-800-692-2489 to refer members to the Behavioral Management Program
  • For plans underwritten by HIP (including GHI HMO and Vytra), call ValueOptions at 1-888-447-2526 to refer members to the Emblem Behavioral Health Services Program.

 

   
  Printer Friendly Page