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  • Directory > Claims Contacts

    Paper claims (CMS 1500 forms) may be sent to the addresses indicated, unless otherwise noted on the member's ID card.

    Claims Contacts
    Plans Type of Claim EDI or Payor ID Clearing House Paper Claim Submission Address Contact for Inquiries
    HIP Medical claims HIP: 55247
    GHI HMO: 25531
    Vendor or direct
    submission
    EmblemHealth
    PO Box 2845
    New York, NY 10116-2845
    emblemhealth.com or
    (866) 447-9717
    HIP Hospital claims HIP: 55247
    GHI HMO: 25531
    Vendor or direct
    submission
    EmblemHealth
    PO Box 2803
    New York, NY 10116-2803
    emblemhealth.com or
    (866) 447-9717
    GHI Medical claims, member-submitted 13551 Vendor or direct
    submission
    EmblemHealth
    PO Box 3000
    New York, NY 10116-3000
    emblemhealth.com or
    (212) 501-4444
    GHI Medical claims, provider-submitted 13551 Vendor or direct submission EmblemHealth
    PO Box 2832
    New York, NY 10116-2832
    emblemhealth.com or
    (212) 501-4444 
    GHI Hospital claims 13551 Vendor or direct
    submission
    EmblemHealth
    PO Box 2833
    New York, NY 10116-2833
    emblemhealth.com or
    (212) 501-4444
    GHI Dental claims Not applicable Vendor or direct
    submission
    EmblemHealth
    PO Box 2838
    New York, NY 10116-2838
    emblemhealth.com or
    (212) 615-4EMC
    Vytra All claims 22264 Vendor or direct
    submission
    Vytra Health Plans
    Attn: Claims Department
    PO Box 9091
    Melville, NY 11747-9091
    emblemhealth.com or
    (888) 288-9872
    CCI CCI VIP Medicare Advantage claims 78375 Vendor ConnectiCare
    PO Box 4000
    Farmington, CT 06034-4000
    (877) 224-8230
    Montefiore CMO HIP claims for members managed by Montefiore CMO 13174 Vendor CMO
    200 Corporate Drive
    Yonkers, NY 10701
    (877) 447-6668
    HealthCare Partners (HCP)[except for members in HCP Cohort 2] HIP claims for members managed by HCP 11328 Vendor HealthCare Partners
    Attn: Claims Department
    501 Franklin Avenue
    Suite 300
    Garden City, NY 11530-5807
    (516) 746-2200 or
    (888) 746-2200
    HCP Cohort 2
    HIP claims for members managed by HCP Cohort 2 55247 Vendor or direct submission
    EmblemHealth
    PO Box 2845
    New York, NY 10116-2845
    emblemhealth.com or 1-866-447-9717
    Palladian
    Muscular
    Skeletal Health
    HIP professional claims for PT/OT services members managed by Palladian and claims billable under the Chiropractic program 37268 Vendor Palladian Health
    PO Box 366
    Lancaster, NY 14086
    palladianhealth.com
    EviCore HIP and GHI claims billable as part of the Radiology program 14182 Vendor/Relay Health EviCore
    400 Buckwalter Place Blvd.
    Bluffton, SC 29910
    (800) 420-3471
    Beacon Health Options Beacon HIP and GHI claims billable as part of the Emblem Behavioral Health Services (HIP members) and EmblemHealth Behavioral Management (GHI members) Programs FHC &Affiliates Vendor EmblemHealth
    PO Box 803
    Latham, NY 12110
    Beacon Health Options or
    (800) 235-3149

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    Glossary terms found on this page:

    Conditions that affect thinking and the ability to figure things out that affect perception, mood and behavior.

    An itemized statement of health care services and their costs provided by a hospital, physician's office or other health care facility. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred.

    The government agency responsible for administering the Medicare and Medicaid programs.

    An organization that provides comprehensive health care coverage to its members through a network of doctors, hospitals and other health care providers. Also called a Health Maintenance Organization.

    An institution which provides inpatient services under the supervision of a physician, and meets the following requirements:

    • Provides diagnostic and therapeutic services for medical diagnosis, treatment and care of injured and sick persons and has, as a minimum, laboratory and radiology services and organized departments of medicine and surgery
    • Has an organized medical staff which may include, in addition to doctors of medicine, doctors of osteopathy and dentistry
    • Has bylaws, rules and regulations pertaining to standards of medical care and service rendered by its medical staff
    • Maintains medical records for all patients
    • Has a requirement that every patient be under the care of a member of the medical staff
    • Provides 24-hour patient services
    • Has in effect agreements with a home health agency for referral and transfer of patients to home health agency care when such service is appropriate to meet the patient's requirements

    A card which allows the subscriber to identify himself or his covered dependents to a provider for health care services.

    The group of individuals who provide person-centered care coordination and care management to participants in a FIDA plan. Each participant will have an interdisciplinary team (IDT). Each IDT will be comprised, first and foremost, of the participant and/or his or her designee, and the participant’s designated care manager, primary care physician, behavioral health professional, home care aide, and other providers either as requested by the participant or his or her designee or as recommended by the care manager or primary care physician and approved by the participant and/or his or her designee. The IDT facilitates timely and thorough coordination between a FIDA plan and the IDT, primary care physician and other providers. The IDT makes coverage determinations. Accordingly, the IDT’s decisions serve as service authorizations, may not be modified by a FIDA plan outside of the IDT, and are appealable by the participant, their providers and their representatives. IDT service planning, coverage determinations, care coordination and care management are delineated in the participant’s person-centered service plan and are based on the assessed needs and articulated preferences of the participant.



    Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.

    A nationwide insurance program for the disabled and people age 65 and over, created by the 1965 amendments to the Social Security Act and operated under the provisions of the Act. It consists of two separate but coordinated programs, Part A and Part B.

    An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program. Also known as MA.

    An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.

    A medical practitioner or covered facility recognized by EmblemHealth for reimbursement purposes. A provider may be any of the following, subject to the conditions listed in this paragraph:

    • Doctor of medicine
    • Doctor of osteopathy
    • Dentist
    • Chiropractor
    • Doctor of podiatric medicine
    • Physical therapist
    • Nurse midwife
    • Certified and registered psychologist
    • Certified and qualified social worker
    • Optometrist
    • Nurse anesthetist
    • Speech-language pathologist
    • Audiologist
    • Clinical laboratory
    • Screening center
    • General hospital
    • Any other type of practitioner or facility specifically listed in the member's Certificate of Insurance as a practitioner or facility recognized by EmblemHealth for reimbursement purposes

    A provider must be licensed or certified to render the covered service. The covered service must be within the scope of the Provider's license or certification.

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