How SAA Works
With over 75 years of experience providing quality health care coverage in New York State, we have established solid relationships with doctors and hospitals in our region and are well-positioned to manage our providers' expectations.
EmblemHealth will continue to adjudicate claims for network practitioners and facilities the way they are accustomed to. With consistent claims pricing and seamless claims payments, network doctors can focus on providing care to your members and not be concerned with how and when their claims will be paid.
This translates into provider satisfaction and deep discounts to your members.
How the SAA Program Works
- The plan member easily finds a network provider through our provider lookup tool, available through your Fund’s Web site.
- The member receives care from a network provider.
- The member is only responsible for the applicable copay, deductible, coinsurance and noncovered service charges.
- The network provider sends the claim to EmblemHealth.
- EmblemHealth applies network benefits and claim adjudication edits at our discounted rate.
- EmblemHealth transfers the claim file to your Fund for confirmation.
- EmblemHealth pays the network provider.
- Your Fund adjudicates and pays the out-of-network provider.