VOLUME 2 | ISSUE 5  •  JUNE 2016


Be Prepared for the NYSDOH Directory Audit

This audit is conducted on an annual basis and includes Primary Care and Obstetrics and Gynecology practitioners. (More)

  • Prepare your office for the NYSDOH call
    Confirm the accuracy of your information in our online directory. Verify that the practice details under each plan are correct on our website, particularly your telephone number, practice location(s), specialty and hospital affiliations.
  • Ensure your staff is familiar with the networks in which you participate
    Once you have confirmed the accuracy of your practice information, make sure each staff member that answers the phone has fast access to a list of the networks in which your practice participates.

If you can't update your information online, fax your changes to our Provider Modifications team at 1-877-889-9061. You may also mail your changes to: Provider Modifications Team, 55 Water Street, 6th Floor, New York, New York, 10041-8190.

Striving for Five

The PCP Incentive Program Has Launched — Everyone Wins When We Work Together to Improve Quality

Check out the details in our Provider Manual.

Doctors: Let Patients Know What Their Care Options Are When Your Office
Is Closed

To help combat costly use of hospital emergency rooms for nn-urgent medical situations, please build these options into your care plan and use this flyer to educate your patients so they know where to access the appropriate level of care during non-office hours.

New Benefit Plan Design for CNY Employees Starts July 1, 2016

Coverage for City of New York Employees and Non-Medicare Eligible Retirees will include a tiered cost-sharing option beginning on July 1, 2016. The new benefit design will allow members to enjoy reduced copayments when they obtain care from certain participating provider groups. The new benefit plan design was developed jointly with City of New York benefit leadership and constructed to offer members interested in a lower copayment an option to reduce their out of pocket expenses. (More)

Claims Corner


Correct Use Promotes Accurate Claim Payments

When filing claims, remember to use the correct taxonomy codes that represent the specific specialty rendering services and always include all diagnosis codes on your claims.

EmblemHealth Follows CMS Correct Coding Guidelines

EmblemHealth evaluates the appropriateness of Evaluation and Management (E&M) service levels for EmblemHealth benefit plans underwritten by HIP Health Plan of New York. Based on the outcome of this evaluation, your payment may be adjusted if the information submitted does not support the level of service billed. (More)

Do Not Balance Bill Medicaid

Medicare and Medicaid payment (if any) must generally be accepted as payment in full. Per State Regulation 18 NYCRR Section 360-7.7, a provider of a Medicare Part B benefit cannot seek to recover any Medicare Part B deductible or coinsurance amounts from Medicare/Medicaid Dually Eligible Individuals. (More)

Use Quest Diagnostics

Quest is our preferred free-standing, independent commercial lab. Quest helps members receive maximum plan benefits with lower out-of-pocket expenses and ensures complete clinical outcome data reporting to EmblemHealth. Members should be directed to the nearest Quest Laboratory Patient Service Center. If you need to establish an account with Quest, please contact them at 1-866-697-8378.

For specialty lab tests not available from Quest, you may use one of the other contracted, free-standing, independent commercial labs. Members may also receive services at hospital-affiliated labs, where covered under the hospital agreement with us.

Medical Guideline Updates and Additions



Religion is Key in Cultural Competency
Properly addressing religion is a key element of providing patient-centered care and improving health outcomes and patient and family satisfaction. The Medical Manual for Religio-Cultural Competency is the most comprehensive guide to religion and health care available. It provides practical information to help practitioners understand how a patientís medical decisions can be influenced by their religious observances. EmblemHealth is pleased to offer this first-of-its-kind publication at no cost to our network practitioners. Sign on to the secure provider site to get a FREE copy of The Medical Manual.


Monthly Instructor-Led Webinars

For in-depth information about our Networks, benefit plans, web-based tools and resources, join us for one of our monthly live Webinars.

Offered the second Wednesday of each month, at 10 am and 2 pm, this informational session shows you how to get the most value from our website.

All instructor-led webinars are hosted by EmblemHealth provider network staff who can answer questions in real time. Space is limited, so register early.

Register today.

Identity Theft:
Learn How to Protect Yourself

In this three-part video interview, Dr. Shantanu Agrawal, Director of the Centers for Medicare & Medicaid Servicesí (CMS) Center for Program Integrity (CPI), discusses medical identity theft and its impact on healthcare providers. Dr. Agrawal provides actionable advice to help providers protect themselves and report suspected identity theft. He also discusses the role Medicare Parts C and D health plans play and the initiatives CMS has undertaken to address this issue.

Coming Soon:
Required SNP MOC Training

Each year, as mandated by the Centers for Medicare & Medicaid Services (CMS), all providers in the Medicare Choice PPO Network and the VIP Prime Network are required to complete the Special Needs Plan (SNP) Model of Care (MOC) Training for each of the Dual Eligible SNPs in which they participate. In June 2016, you will receive an ID/PIN number to take this online training. Providers without computers may request a printed version and attestation of completion to return to us for tracking and reporting to CMS.

Know Your Network Participation

Your provider profile on emblemhealth.com lists your network affiliations. If the network information on the member's ID card matches your network affiliations, then you are in-network for that member's benefit plan. See the Provider Networks and Member Benefit Plans chapter of the EmblemHealth Provider Manual for a listing of all networks and plans.

Help Your Patients Stay Fit

EmblemHealth has health and wellness programs, and tools and resources to help members stay fit and enhance their quality of life. EmblemHealth members have access to Healthy Discounts at no additional cost. Participating vendors offer discounts for health club memberships, acupuncture, massage therapy and nutrition counseling, weight loss services, hearing and vision care, vitamins and supplements, and other comprehensive health care services and products.

EmblemHealth Neighborhood Care

Visit EHNC for a list of community events and information on all that EmblemHealth Neighborhood Care has to offer.


  • Harlem
    215 W 125th St., New York, NY 10027
  • Cambria Heights
    206-20 Linden Blvd.,
    Cambria Heights, NY 11411
  • Chinatown
    87 Bowery, New York, NY 10002
  • Crown Heights NEW LOCATION
    546 Eastern Parkway,
    Brooklyn, New York 11225

Hours for ALL locations:
Mon - Fri: 10 am - 6:30 pm
Sat: 10 am - 3:30 pm




Do More On the Go!

Our myEmblemHealth mobile app provides useful benefit and plan information for members, right at their fingertips:

•  Search for a doctor or hospital

•  See copay, benefit and claims information

•  Access their ID card

•  Pay their bill

•  View their physician (PCP)

Easy access — anytime, anywhere! Encourage your patients to download it today. Available on all iOS and Android devices.




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Coverage underwritten by Group Health Incorporated (GHI) and HIP Health Plan of New York (HIP).
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