ConsumerDirect Benefit Plans Submit Claims to Us First

(Applies to ConsumerDirect EPO and ConsumerDirect PPO)

Please submit your claims for medical care for members in ConsumerDirect EPO or ConsumerDirect PPO benefit plans to EmblemHealth. You can expedite reimbursement and avoid payment errors by submitting your claims to us and billing your patient after you receive and review your Explanation of Benefits (EOB) for the claim(s).

Because member liability is determined after a claim is processed, the EOB will clearly state the member’s payment responsibility. If any coinsurance or deductible remains, you may bill your patient directly for the balance.