New Prior Approval List —
Effective January 22, 2014
Beginning January 22, 2014, a new prior approval list will apply to all commercial and state-sponsored benefit plans underwritten by HIP Health Plan of New York, HIP Insurance Plan of New York and Vytra Health Plans Managed Systems.
Coming Soon: New Features for www.emblemhealth.com
Manage Agents on a Group Level: Group practices can now register all users in an office under one Tax ID number. This allows Office transactions to be managed on a group level.
New Prior Approval Look-up Tool: GHI HMO providers can now use the Prior Approval site to review the status of in and out-patients.
New Care Management Protocols for GHI HMO
GHI HMO providers must create referrals and make prior approval requests via EmblemHealth’s secure portal; this will help to maintain accuracy. Hospitals can submit ER Admission Notifications which trigger the creation of an inpatient case that can be followed on the website. Each submission generates a date and time-stamped receipt of the notification. Online is available as well.
GHI HMO providers who don’t participate with HIP will be sent a user ID for access to our secure provider portal. Existing user IDs will continue to work for most transactions. However, registration under this new number will be required to access the Referral, Prior Approval and ER-Admission Notification screens. If you are already a HIP provider registered to use these screens, you do not need to register again. GHI HMO information will automatically be added to your HIP account. For example, PCP Rosters will have GHI HMO added to the report.
Effective December 26, 2013, pediatricians who participate with our HIP, EmblemHealth CompreHealth EPO/HMO and Vytra plans may perform CPT 85025 (complete blood count with differential WBC, automated) in an office setting (POS 11) without a prior approval when clinically appropriate.
Improved Provider Customer Service
Same phone numbers, new prompts. Please listen for new routing instructions. Sign-in with your TIN and transact business for any EmblemHealth, GHI or HIP member!
Reminder: ConnectiCare Is an EmblemHealth Affiliate
Please be aware that ConnectiCare is an affiliate of EmblemHealth. This means most participating EmblemHealth practitioners are part of the ConnectiCare provider network and are included in ConnectiCare’s Provider Directory.
To access the ConnectiCare Provider Directory, please visit www.connecticare.com/ProviderDirectory. We appreciate your cooperation in assisting ConnectiCare members in accessing quality health care.
For billing or eligibility questions, please visit www.connecticare.com/provider, or contact Provider Services at 1-800-828-3407. If you would like to speak to a Provider Education and Service Representative, contact Cindy Osle-Elmer at 1-860-409-8966.
Visit ehnc.com for more information on all that EmblemHealth Neighborhood Care has to offer you and your patients.
Upcoming Provider Forums
We urge you to attend this workshop for instruction on how to manage Select Care network-based plans beginning
January 1, 2014.
Tuesday, January 28, 2014
3 to 5 pm
Cambria Heights EmblemHealth
206-20 Linden Boulevard
Cambria Height, NY 11411
Light refreshments will be served.
The objective of this workshop is to help you:
Understand the Select Care network, its composition and plans
Identify members with Select Care network-based plans
See how EmblemHealth's online administrative procedures will make treating members easier
Recognize the value of keeping members in-network
Know why it is important to encourage patients to get health insurance coverage and enroll in the appropriate plan
This forum is also an exciting opportunity to tour our Cambria Heights EmblemHealth Neighborhood Care site to see how we find health care solutions that support the treatment goals for our members and for the community of Cambria Heights.
Registration is limited
Reserve your seat as soon as possible.
Review your information now to ensure you are correctly listed in our EmblemHealth directories. If any of your information has changed or is inaccurate, just follow our simple instructions to update your profile online. Can't update your information online? Fax your changes to our Provider Modifications team at 1-877-889-9061.
Don't forget about changes to Medicare plans and benefits beginning on January 1, 2014
See our Policy Alert for a list of changes that may impact your patients and your practice.
Group Health Incorporated (GHI), HIP Health Plan of New York (HIP), HIP Insurance Company of New York and EmblemHealth Services Company, LLC are EmblemHealth companies. EmblemHealth Services Company, LLC provides administrative services to the EmblemHealth companies.