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Questions about Claims

How do I check the status of my claim?

The quickest, easiest way to check the status of a claim is to go to myEmblemHealth, a special, personalized section of the EmblemHealth website. If you have not yet registered at myEmblemHealth, you can do so now.

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When can I expect to receive my payment invoice?

You can also check the status of claims by calling the EmblemHealth AnswerLine - our automated, touch-tone telephone system - any time day or night. Simply call one of the numbers listed below and enter your 9-digit EmblemHealth member identification number when prompted. It's easy! The recording guides you through a menu of choices, and you can choose the information or materials you need.

There is one IVR for EH customer service - 1-877-842-3625.

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When do I need to file claim forms?

You are not required to file paper claims when you receive covered services from participating EmblemHealth providers. The provider submits the claim directly to EmblemHealth, and is reimbursed directly by EmblemHealth. When you receive covered services from non-participating providers, you may be required to pay the provider directly,   and submit a claim to EmblemHealth for the services that you receive. EmblemHealth will process the claim and then reimburse you directly, according to the terms of your contract.

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If I choose to see an out-of-network doctor, where do I submit my claim form?

To receive reimbursement for covered services from a non-participating provider, you should submit a standard HCFA-1500 health insurance claim form to EmblemHealth.

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How much time do I have to submit claim forms?

For fastest reimbursement, please file claims promptly after receiving services. However, EmbelmHealth's filing period is within 12 months after the date services were rendered.

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