Clinical Corner

Clinical Corner is a resource for practice guidance related to the treatment of acute, chronic and behavioral health issues as well as the medical appropriateness of specific intervention. Click on any subject of interest to access information on that topic.

Looking for information on claims? Visit Claims Corner to find updated information on claims policy, best practices for coding your claims, regulatory-driven payment methodology changes and other useful claims-related tips.

View Clinical Practice Guidelines, evidence-based recommendations to assist practitioners in determining what is covered in medical care under our health benefit plans. Providers will be notified of changes to the Clinical Practice Guidelines in the quarterly provider newsletter News&Notes and in the eNewsFlash. We recommend that network providers check this site monthly to stay current with any updates that are made.

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Information on EmblemHealth’s Injectable Drug Utilization Management Program. The page includes links to guides and forms you can download.
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View EmblemHealth's Medical Policies.
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A comprehensive listing of medical technologies reviewed by the Medical Policy Subcommittee for coverage consideration. See the Medical Technologies Database for 2013.
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The EmblemHealth Commercial and Medicare formularies are compilations of brand and generic pharmaceuticals that have been identified as providing optimal results for plan members while controlling the cost of drug therapy. These formularies are updated regularly through formulary updates.
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EviCore is our vendor for the management of radiology and cardiac imaging procedures. EviCore works to improve utilization and enhance quality by integrating administrative management of patient-centered care.

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Information on new incentive programs for fee-for-service and ACPNY providers.

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EmblemHealth continues to partner with the provider community to continuously improve our members' quality of care and the overall patient experience.

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