Provider Outreach for ADA Attestations —
Prompt Response Is Required

In the coming months, EmblemHealth may request that you re-attest to your office's compliance with the Americans with Disabilities Act (ADA), as required by the Centers for Medicare & Medicaid Services for participation in EmblemHealth, GuildNet and ArchCare, as applicable. Please respond promptly. Failure to respond requires EmblemHealth to suppress your entry in our Fully Integrated Duals Advantage (FIDA) provider directory. For your convenience, you will receive instructions on how to complete this attestation electronically.

New Prior Approval List and Look-Up Tool Now Available

EmblemHealth's revised prior approval list applies to all benefit plans using the following networks: GHI HMO, Premium, Prime, Medicaid Prime, VIP Prime, NY Metro, Select Care and Vytra. For your convenience, we've also added a Prior Approval Look-Up Tool to our secure website.

Register for access to our secure website today:

For GHIRegister each TIN you use on claims you submit for GHI.

For HIP — Register each practice site using your PRIS Number
(AKA directory ID).

Discontinued Products

The following EmblemHealth products were discontinued effective January 1, 2014. All affected members were disenrolled from these plans.


  • Alliance Value and Core Plans
  • Brooklyn Health Works (Healthy NY EPO)
  • Healthy NY EPO
  • Small Business Advantage Plan


  • CompreHealth HMO
  • GHI Direct Pay HMO
  • GHI Direct Pay POS
  • GHI Healthy NY HMO
  • HIP Choice Plus Direct Pay Governor's Bill
  • HIP Classic
  • HIP Healthy NY HMO*
  • HIP HMO Direct Pay Governor's Bill
  • HIP HMO Direct Pay Pre-Governor's Bill

*Please note that a new EmblemHealth Healthy NY HMO Plan, underwritten by HIP, became available for eligible small group business effective January 1, 2014.


Monthly Online Workshops for Practitioners and Office Staff

Topics include:

  • Navigating our secure website
  • Using medical and payment policy tools
  • Identifying EmblemHealth member ID cards and member benefits

Special Presentation by the Alzheimer's Association:
In February, as part of our regular monthly online workshop, the Alzheimer's Association will discuss free programs, resources and other information available to practitioners, patients and caregivers.

Who should attend: Practitioners and their staff members who want to learn about new EmblemHealth products and website updates.

When: Second Wednesday of each month: 10 – 11 am and 2 – 3 pm

To register: Complete and submit an online registration form.



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.

Know Your Network Participation

Your provider profile now lists your network affiliations. Keep this information handy. If the network information on the member's ID card matches your network affiliations, then you are in-network for that member's benefit plan.


Claims Corner

Medicaid Managed Care Permanent Nursing Home Stay Benefit Enhancement

Beginning March 1, 2014 the Medicaid Managed Care nursing home benefit expands to include coverage of permanent stays in residential health care facilities. (More)

Revised Form — NYS Medicaid Prior Authorization Request Form For Prescriptions

The NYS Medicaid Prior Authorization Request Form For Prescriptions is now easier to read and complete, with more thorough instructions.

Coming Soon — 2014 Provider Satisfaction Survey

Want an opportunity to tell us how we're doing? Check your e-mail for the 2014 Provider Satisfaction survey. Please respond online as soon as you receive it — your feedback is important to us.

Online Tools Encourage Overall Health and Wellness

Your EmblemHealth patients now have access to a new health assessment tool from RedBrick. Available from our secure member website, the interactive tool can quickly give your patients an update on their health status and priorities. It can also help them try out and adopt new health behaviors in a fun and reinforcing way.

EmblemHealth Neighborhood Care — Community Events

Visit ehnc.com for a list of community events for the Cambria Heights, Harlem and Chinatown sites and for more information on all that EmblemHealth Neighborhood Care has to offer you and your patients.


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Group Health Incorporated (GHI), 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.