Table of Contents
Search
How Do I...

Search Tips

Table of Contents Search

  • For more specific results, select both a chapter and section.
  • To move from section to section within a chapter, use the left navigation bar.

Keyword Search

  • For best results, select a recommended search term if one appears in the search box.
  • To narrow your search, use the Filter By and Additional Keywords features in the left navigation bar.
  • To find an exact phrase, use quotes (e.g., “prior approval”).
  • To find all search terms, use the word AND in capital letters between search terms.
  • To find at least one search term, use the word OR in capital letters between search terms.
×
  • Directory > Claims Contacts

    Paper claims (CMS 1500 forms) may be sent to the addresses indicated, unless otherwise noted on the member's ID card. 
      Claims Contacts
      Plans Type of Claim EDI or Payor ID Clearing House Paper Claim Submission Address Contact for Inquiries

      HIP

      Medical claims

      HIP: 55247
      GHI HMO: 25531

      Vendor or direct
      submission

      EmblemHealth
      PO Box 2845
      New York, NY 10116-2845

      www.emblemhealth.com or
      (866) 447-9717

      HIP

      Hospital claims

      HIP: 55247
      GHI HMO: 25531

      Vendor or direct
      submission

      EmblemHealth
      PO Box 2803
      New York, NY 10116-2803

      www.emblemhealth.com or
      (866) 447-9717

      GHI

      Medical claims, member-submitted

      13551

      Vendor or direct
      submission

      EmblemHealth
      PO Box 3000
      New York, NY 10116-3000

      www.emblemhealth.com or
      (212) 501-4444

      GHI Medical claims, provider-submitted 13551 Vendor or direct submission EmblemHealth
      PO Box 2832
      New York, NY 10116-2832

      www.emblemhealth.com or
      (212) 501-4444 

      GHI

      Hospital claims

      13551

      Vendor or direct
      submission

      EmblemHealth
      PO Box 2833
      New York, NY 10116-2833

      www.emblemhealth.com or
      (212) 501-4444

      GHI

      Dental claims

      Not applicable

      Vendor or direct
      submission

      EmblemHealth
      PO Box 2838
      New York, NY 10116-2838

      www.emblemhealth.com or
      (212) 615-4EMC

      Vytra

      All claims

      22264

      Vendor or direct
      submission

      Vytra Health Plans
      Attn: Claims Department
      PO Box 9091
      Melville, NY 11747-9091

      www.vytra.com or
      (888) 288-9872

      CCI

      CCI VIP Medicare Advantage claims

      78375

      Vendor

      ConnectiCare
      PO Box 4000
      Farmington, CT 06034-4000

      (877) 224-8230

      Montefiore CMO

      HIP claims for members managed by Montefiore CMO

      13174

      Vendor

      CMO
      200 Corporate Drive
      Yonkers, NY 10701

      (877) 447-6668

      HealthCare Partners (HCP)

      HIP claims for members managed by HCP

      11328

      Vendor

      HealthCare Partners
      Attn: Claims Department
      501 Franklin Avenue
      Suite 300
      Garden City, NY 11530-5807

      1-516-746-2200 or
      1-888-746-2200

      Palladian
      Muscular
      Skeletal Health

      HIP professional claims for PT/OT services members managed by Palladian and claims billable under the Chiropractic program

      37268

      Vendor

      Palladian Health
      PO Box 270
      Lancaster, NY 14086

      www.palladianhealth.com

      EviCore

      HIP and GHI claims billable as part of the Radiology program

      14182

      Vendor/Relay Health

      EviCore
      400 Buckwalter Place Blvd.
      Bluffton, SC 29910

      800 420 3471

      ValueOptions/ Beacon

      HIP and GHI claims billable as part of the Emblem Behavioral Health Services (HIP members) and EmblemHealth Behavioral Management (GHI members) Programs

      FHC &Affiliates

      Vendor

      EmblemHealth
      PO Box 803
      Latham, NY 12110
      www.ValueOptions.com or
      (800) 235-3149

      My Subscriptions

      Enter your e-mail address to receive a link to your subscriptions.

      Submit
      ×

      Glossary terms found on this page:

      Conditions that affect thinking and the ability to figure things out that affect perception, mood and behavior.

      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.

      The government agency responsible for administering the Medicare and Medicaid programs.

      An organization that provides comprehensive health care coverage to its members through a network of doctors, hospitals and other health care providers. Also called a Health Maintenance Organization.

      An institution which provides inpatient services under the supervision of a physician, and meets the following requirements:

      • Provides diagnostic and therapeutic services for medical diagnosis, treatment and care of injured and sick persons and has, as a minimum, laboratory and radiology services and organized departments of medicine and surgery
      • Has an organized medical staff which may include, in addition to doctors of medicine, doctors of osteopathy and dentistry
      • Has bylaws, rules and regulations pertaining to standards of medical care and service rendered by its medical staff
      • Maintains medical records for all patients
      • Has a requirement that every patient be under the care of a member of the medical staff
      • Provides 24-hour patient services
      • Has in effect agreements with a home health agency for referral and transfer of patients to home health agency care when such service is appropriate to meet the patient's requirements

      A card which allows the subscriber to identify himself or his covered dependents to a provider for health care services.

      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 nationwide insurance program for the disabled and people age 65 and over, created by the 1965 amendments to the Social Security Act and operated under the provisions of the Act. It consists of two separate but coordinated programs, Part A and Part B.

      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. Also known as MA.

      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.

      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.

      Provides managed mental health and substance abuse (MHSA) programs, workplace services, employee assistance programs (EAP), psychiatric disability management, Medicaid behavioral health management and child welfare programs for over 23 million lives. Visit the ValueOptions Web site at www.valueoptions.com.

      ×

    You are now leaving the Medicare section of the EmblemHealth website.

    Click to Continue ×

    Your member ID # is on the front of your ID card.