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  • Directory > Additional Resources (Providers and Members)

    Additional Resources (Providers and Members)

    Entity

    Address

    Phone

    Email/Comments

    Chiropractic and Physical/Occupational Therapy

    Palladian Muscular Skeletal Health

    2732 Transit Road
    West Seneca, NY 14224

    (877) 774-7693

    www.palladianhealth.com

    Delegated for utilization management.

    Dental Services

    Careington International Corp.
    (For HIP Preventive Dental)

    7400 Gaylord Parkway
    Frisco, NY 75034

    Providers:
    (800) 290-0523

    Members:
    (877) 548-4447

    www.careington.com

    Delegated for credentialing.

    Healthplex
    (Dental claims for HIP members participating in Medicaid, CHPlus or HIP Prime)

    333 Earle Ovington Blvd.
    Ste 300
    Uniondale, NY 11553-3608

    Providers:
    (516) 542-2600

    Claims:
    (888) 468-2183

    Members:
    (800) 468-9868

    www.healthplex.com

    Delegated for credentialing, utilization management and claims processing.

    Managing Entities

    HealthCare Partners (HCP)

    501 Franklin Ave., Suite 300
    Garden City, NY 11530-5807

    (516) 746-2200 or
    (888) 746-2200

    www.hcpipa.com

    Delegated for credentialing, utilization management, claims processing and first call resolution.

    Montefiore CMO

    100 Corporate Drive
    Yonkers, NY 10701

    (877) 447-6668

    www.montefiore.org

    Delegated for credentialing, utilization management and claims processing.

    Radiology Services

    eviCore

    P.O. Box 61022
    Anaheim, CA 92803

    (800) 918-8924

    www.evicore.com

    Vision Services

    Davis Vision
    (For GHI members only)

    159 Express St.
    Plainview, NY 11803

    (800) 999-5431

    Delegated for credentialing and claims processing.

    Comprehensive Professional Systems
    (For HIP members only)

    11 Hanover Square
    New York, NY 10005

    (212) 675-5745

    EmblemHealth conducts claims processing.

    Eye Care Advantage
    (For HIP members only)

    1953 Grand Avenue
    Baldwin, NY 11510

    (516) 623-3700

    EmblemHealth conducts claims processing.

    General Vision
    (For HIP members only)

    520 Eighth Avenue
    New York, NY 10018

    (800) 847-4661

    EmblemHealth conducts claims processing.

    Injectables and Specialty Pharmacy Program

    ICORE National, LLC

    5850 T.G. Lee Blvd.,
    Suite 510
    Orlando, FL 32822

    (800) 424-4088

    www.icorehealthcare.com

    Delegated for utilization management.

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    Glossary terms found on this page:

    An itemized statement of health care services and their costs provided by a hospital, physician's office or other health care facility. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred.

    An entity contracted with EmblemHealth to perform various services including utilization review, credentialing and claims processing. Also called managing entities and carve outs.

    An organization comprised of individual physicians or physicians in group practices that contracts with the managed care organization on behalf of its member physicians to provide health care services. Also called an Independent Practice Association.

    Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.

    A jointly funded federal and state program that provides hospital and medical coverage to the low-income population and certain aged and disabled individuals.

    An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.

    Treatment to restore a physically disabled person's ability to perform activities such as walking, eating, drinking, dressing, toileting and bathing (activities of daily living).

    A medical practitioner or covered facility recognized by EmblemHealth for reimbursement purposes. A provider may be any of the following, subject to the conditions listed in this paragraph:

    • Doctor of medicine
    • Doctor of osteopathy
    • Dentist
    • Chiropractor
    • Doctor of podiatric medicine
    • Physical therapist
    • Nurse midwife
    • Certified and registered psychologist
    • Certified and qualified social worker
    • Optometrist
    • Nurse anesthetist
    • Speech-language pathologist
    • Audiologist
    • Clinical laboratory
    • Screening center
    • General hospital
    • Any other type of practitioner or facility specifically listed in the member's Certificate of Insurance as a practitioner or facility recognized by EmblemHealth for reimbursement purposes

    A provider must be licensed or certified to render the covered service. The covered service must be within the scope of the Provider's license or certification.

    A review to determine whether covered services that have been provided or are proposed to be provided to a member, whether undertaken prior to, concurrent with or subsequent to the delivery of such services are medically necessary. Also called Coordinated Care.

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