Reduce Costs and Simplify Benefits Administration with EmblemHealth Network Access

Network Access ProgramFor hassle-free benefits administration, quality physician and hospital networks and cost-saving fee schedules, consider the advantages of leasing with the EmblemHealth Network Access program.

Network Access

Network Access gives your group members access to our extensive PPO network, which includes many of the area's leading physicians, other medical practitioners and acute care hospitals.

Flexibility

Network Access gives you the flexibility to choose how to price claims, giving you complete control over your benefits administration. Lease our hospital network, medical network, or both.

Extensive Networks Provide Quality Care

Our medical network provides access to a wide range of medical practitioners and includes:

  • Primary care physicians and specialists, including pediatricians, OB/GYNs, cardiologists, oncologists and more
  • Mental health inpatient and outpatient services provided through an alliance with ValueOptions®
  • Ancillary providers, including skilled nursing facilities, medical equipment and vision care
  • Clinical laboratories, such as Quest Diagnostics

Our hospital network includes nearly every acute-care hospital, including Memorial Sloan-Kettering Cancer Center, Northern Westchester Hospital Center, St. Francis Heart Center and many others.

Deep Discounts Mean Significant Savings

Our longstanding relationships with participating providers have enabled us to negotiate sizable payment discounts, which provide exceptional savings like these:

  • Medical Network reimbursement schedule produces discounts of 75% to 80% of RBRVS (Resource Based Relative Value Scale).
  • Hospital Network reimbursement schedule produces savings of up to 40% to 60%.

Security You Can Trust

Network Access uses the HIPAA 837 format and a secure Web re-pricing portal to ensure that your claims transmittal is secure and confidential.

Claims Pricing Options

You may utilize one or both of the following claims pricing options:

Mainframe Pricing by EmblemHealth Online Pricing by Client
For clients who want to submit claims electronically, EmblemHealth prices systemically and returns them to the client for processing and payment. Authorized benefit administration staff can price claims at their own convenience via remote Internet access to the EmblemHealth Network Access provider claims re-pricing system.

Value-Added Health and Wellness Programs

EmblemHealth’s Healthy Discounts Program offers your group discounts on weight-loss and exercise programs, hearing aids, massage therapy and more at no additional cost — to help your group members get healthy and stay healthy. And healthy members can mean lower claims costs.