In This Issue:

HIP Service Area Expansion Affects GHI HMO Providers

New Prior Approval List

New Web Usage Requirements for GHI HMO Network Providers

New EmblemHealth Radiation Therapy Program and EmblemHealth Cardiology Imaging Program and HIP Radiology Programs Apply to More Members

Updated Fax Forms for: EmblemHealth Injectable Drug Utilization Management Program

EmblemHealth Consolidates Post Office Boxes for GHI HMO and EmblemHealth Medicare PPO

Claims Corner

Medicaid and Medicare Updates

Behind the Scenes

Case Management Programs

Stressing the Importance of Prenatal Visits

Well-Child Visits

High-Risk Medications for Elderly Patients

Healthful Aging Starts With Lifestyle Changes and Preventive Screenings

Talking With Patients About Urinary Incontinence

Treating Rheumatoid Arthritis

Assisting Patients Living With HIV

Treating Low Back Pain

Asthma Management

CPT Codes for Tobacco Cessation Counseling

Clinical Corner

News&Notes Archive

Case Management Programs

EmblemHealth case managers assess, plan, implement, coordinate, monitor and evaluate treatment and support services to meet the medical, behavioral and high-risk maternal health care needs of identified members. Case managers and social workers educate members about their health condition, coordinate health care services and serve as an advocate and liaison between members and their families, caregivers, physicians and other clinical staff on the health care team.

EmblemHealth case managers and social workers also collaborate with primary care physicians, mental health professionals and high-risk obstetricians to ensure that each member's complex and often competing medical needs are addressed and that care solutions are implemented. Our Complex Case Management program assists medical professionals in meeting the needs of our members with acute, chronic and disabling conditions such as:

  • Transplants (solid organ and bone marrow)
  • Compromised neonates
  • Psychiatric and substance abuse (particularly those cases with significant psychiatric history)
  • Traumatic or catastrophic events

To learn more about our case management programs and the criteria for enrolling patients into the programs, please see the EmblemHealth Provider Manual.

To refer a patient to the EmblemHealth Complex Case Management program, please call 1-800-447-0768 or the phone number on the back of the patient's ID card. To refer a high-risk maternity patient to Healthy Beginnings PATH, our pregnancy management program for eligible EmblemHealth, GHI and HIP plan members, please call 1-888-447-0337.

If you have questions about mental health or substance abuse care for members in our EmblemHealth CompreHealth, GHI HMO, HIP, Vytra and EmblemHealth Medicare HMO plans, please call us at 1-888-447-2526. For GHI BMP PPO members, please call 1- 866-271-6403; for GHI Medicare PPO members, call 1-866-318-7595.To locate a provider in the Emblem Behavioral Health Services program, use our Find a Doctor tool.

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