MAY 2013


Visit Our New Site, Launching This Summer

We are redesigning to enhance its look and feel, improve navigation and make it easier to find the information you need. The site is scheduled to launch at the end of June 2013. More

Claims Corner

New Accreditation and Certification for
Outpatient Diagnostic Imaging Begins July 1

Effective July 1, 2013, the EmblemHealth Outpatient Diagnostic Imaging Self-Referral Payment Policy (SRPP) will 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 (POS11). Prior approval rules will continue to apply where applicable. Certain groups are excluded from this policy. More

New PT/OT/ST Prior Approval Rules for
Medicare PPO Members Begin August 1

Effective August 1, 2013, EmblemHealth will implement new prior approval rules for physical, occupational and speech therapy for our Medicare PPO members. Under the new policy, we will require prior approval for these services after the sixth visit. More

Clinical Corner

Formulary Updates
Review the most recent changes to our Commercial Premier/Child Health Plus, Commercial Select and Medicaid/Family Health Plus formularies. Also review our Medicare PPO/HMO and Medicare Prescription Drug Plan (PDP) formularies.

Medical Technologies Database
See all the medical technologies our Medical Policy Subcommittee has reviewed for coverage consideration and which technologies are covered benefits.

Health Alerts
See the latest clinical health and medication alerts.


Visit EmblemHealth Neighborhood Care

The dedicated staff of EmblemHealth Neighborhood Care are available to you and your patients Monday through Saturday, from 10 am to 7 pm. Stop by one of our two locations and experience what we have to offer. Our on-site clinical support team, including a registered nurse and a pharmacist, are available to provide your patients with health education and medication support. They can also connect your patients with programs designed to help them comply with your treatment goals.

Don't have time to stop by? Take an online tour.

  • EmblemHealth Neighborhood Care – Harlem
    215 West 125th Street
    New York, NY 10027
    Phone: 1-866-469-0999
  • EmblemHealth Neighborhood Care – Cambria Heights
    206-20 Linden Boulevard
    Cambria Heights, NY 11411
    Phone: 1-866-539-0999




Monthly Webinars for Practitioners and Office Staff

Topics include:

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

Who should attend: Practitioners and their staff members who want to learn about new EmblemHealth products and Web site updates.

When: Second Wednesday of each month; 10–11 am and 2–3 pm

To register: Complete and submit an online registration form.




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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.

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