Your Opinion Matters

EmblemHealth conducts an annual Provider Satisfaction Survey, which is now underway. If you received this survey, please take a few minutes to complete it either on paper or online. We appreciate your prompt response.

Upcoming Medical Record
Audits for 2013

EmblemHealth conducts medical record audits to ensure we comply with Centers for Medicare & Medicaid Services and New York State Department of Health regulatory requirements, as well as National Committee for Quality Assurance standards of patient care. Here are some audits you can expect in 2013:

See our provider manual and News&Notes for more information and resources on medical record standards.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

Transportation Benefit Updates

On January 1, 2013, the transportation benefit changed for both Medicaid Managed Care and Family Health Plus (FHPlus)* members enrolled in
New York City:

  • Medicaid: Emergency and nonemergency medical transportation are covered by regular Medicaid.
  • FHPlus: Only nonemergency medical transportation is covered by regular Medicaid.

HIP no longer covers emergency and nonemergency transportation for our NYC Medicaid enrollees, nor nonemergency transportation for NYC FHPlus members. This means HIP-participating practitioners no longer need to reimburse NYC-enrolled Medicaid and FHPlus members for the cost of transportation to and from medical appointments. More

*Includes UFT FHPlus.

Claims Corner

New Diagnostic Imaging Self-Referral Policy
In July 2013, EmblemHealth will institute an Outpatient Diagnostic Imaging Self-Referral Payment Policy (SRPP) to replace HIP's Radiology and Cardiology Imaging Privileging programs. The policy defines the minimum accreditation and certification requirements by specialty for diagnostic imaging conducted in an office setting. Prior approval rules will continue to apply where applicable. More


Monthly Webinars

Please join us for a no-cost Webinar on the second Wednesday of each month, from 10 am to 11 am and 2 pm to 3 pm, to help you manage your business with us. All you need is Internet access, a phone and an hour.

Web topics include:

  • Navigating our Web site
  • Using medical and payment policy tools
  • Identifying EmblemHealth member ID cards and member benefits

Register Now
To register, complete and submit an online registration form.

Save the Date: EmblemHealth Forums for Practitioners and Office Staff

We're offering the following on-site forum, which is open to all NYC practitioners and their office staff. Seating is limited, so register today.


Friday, April 26, 2013
9:30 am to noon
Staten Island: South Fin Grill in the Vanderbilt at South Beach
Contact Larissa Swanberg-Obadia



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Group Health Incorporated (GHI), GHI HMO Select, Inc. (GHI HMO), 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.