MARCH 2013

 

Coming Soon:
Appointment Availability and Access Surveys

As mandated by the New York State Department of Health (NYSDOH), each spring and fall EmblemHealth conducts phone surveys of randomly selected primary care and specialty practitioners to determine whether they are meeting both the Appointment Availability and After Hours Office Access Standards. We conduct these surveys to determine individual practitioner and overall network compliance with NYSDOH standards. More

EmblemHealth Neighborhood Care —
What Care Feels Like

Based in Harlem and Cambria Heights, Queens, Neighborhood Care offers our plan members and other local residents a place to get the personalized, one-on-one support of clinical, medical benefit and health management experts. This new service also aims to break down barriers to patient care. Visitors can access health-related tools and resources and get expert help navigating the health care system. Neighborhood Care does not provide medical services; instead, it's designed to support your patient relationships and ensure your patients understand and comply with your treatment plans. We're offering related Webinars over the next several months; for details, see "Introducing Neighborhood Care" to the right. More

Location Address/Phone Hours of Operation
Harlem 215 West 125th St.
New York, NY 10027
Phone: 1-866-469-0999
Mon-Sat, 10 am-7 pm Closed on Sundays
Cambria Heights,
Queens
206-20 Linden Blvd.
Cambria Heights, NY 11411
Phone: 1-866-539-0999
Mon-Sat, 10 am-7 pm Closed on Sundays

Claims Corner

Revised Look Back Period for Medicare Advantage
Due to recent legislation, the "look back" period for Medicare Advantage claims has been revised as follows:

  • Pre-American Taxpayer Relief Act of 2012: Within one year for any reason and three years after the year in which payment was made for good cause (new and material evidence has come to light)
  • Post-American Taxpayer Relief Act of 2012: Within one year for any reason and five years after the year in which payment was made for good cause (new and material evidence has come to light)

The look back period for all other EmblemHealth lines of business has not changed. More

Vaccine Reimbursement: Vaccines for Children Program
Vaccines for Medicaid and Child Health Plus members must be obtained through the Vaccines for Children (VFC) program in order to receive them free of charge. EmblemHealth will not reimburse practitioners for the cost of vaccines available through the VFC program. Practitioners choosing not to enroll in the VFC program may not bill EmblemHealth or the member for the cost of vaccines. We do, however, pay for the cost of vaccine administration.

For Medicaid and Child Health Plus members enrolled in New York City, EmblemHealth is responsible for both the vaccine and administration costs for CPT codes 90650, 90681, 90714, 90734, 90696 and 90698. For all other New York counties, we are responsible for the cost of vaccine administration only.

 

 

Monthly Webinars for Practitioners and Office Staff

We host monthly, no-cost Webinars to help you manage your business with us. They take place on the second Wednesday of each month, from 10 am to 11 am and again from 2 pm to 3 pm. All you need is Internet access, a phone and an hour. These Webinars are beneficial for new practitioners and new office staff.

Web topics include:

  • Navigating our Web site, www.emblemhealth.com
  • Using medical and payment policy tools
  • Identifying EmblemHealth member ID cards and member benefits

Register Now
To register, complete and submit an online registration form.

 
 

Specialized Webinars

Get firsthand exposure to new EmblemHealth programs and policies. All you need is Internet access, a phone and an hour. Participation is limited, so register today. To learn more, contact Larissa Swanberg-Obadia at 1-631-844-2520 or by e-mail.

Introducing Neighborhood Care

Get a virtual tour of Neighborhood Care and the many support services available to your patients, including wellness resources, medication support and health plan navigation.

Thursday, March 28, 2013
Choose from two sessions:
10-11 am or 2-3 pm
To register, complete and submit an online registration form.

For HealthCare Partners Practitioners and Office Staff Joining EmblemHealth

Get the tools and information you need to manage your transition to EmblemHealth. You'll learn how to:

  • Navigate features of www.emblemhealth.com
  • Generate new referrals and prior approval requests
  • Facilitate continuity and transition of care
  • Keep your profile information current

Wednesday, April 17, 2013
Choose from two sessions:
10-11 am or 2-3 pm
To register, complete and submit an online registration form.

 

EmblemHealth Forum For Practitioners and Office Staff

We're offering the following on-site forum, which is beneficial for both new practitioners and new office staff. Seating is limited, so register today. Topics include:

  • Navigating our Web site, www.emblemhealth.com
  • Using medical and payment policy tools
  • Identifying EmblemHealth member ID cards and member benefits

Friday, April 26, 2013
9:30 am to noon
Staten Island: South Fin Grill in the Vanderbilt at South Beach
To register, contact Larissa Swanberg-Obadia by e-mail.

 

 

 
 

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Group Health Incorporated (GHI), GHI HMO Select, Inc. (GHI HMO), HIP Health Plan of New York (HIP), HIP Insurance Company of New York and EmblemHealth Services Company, LLC are EmblemHealth companies. EmblemHealth Services Company, LLC provides administrative services to the EmblemHealth companies.

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