This manual applies to all EmblemHealth plans and is an extension of your Provider Agreement. It includes detailed information about your administrative responsibilities, and contractual and regulatory obligations. It also details best practices for interacting with our plans and helping our members navigate their health care.
**The online manual is updated regularly. Please do not refer to any previously downloaded PDF.
| Overview | Chapter 1 |
| Directory | Chapter 2 |
| Credentialing | Chapter 3 |
| Member Identification Cards | Chapter 4 |
| Member Policies and Rights |
Chapter 5 |
| 2023 Provider Networks and Member Benefit Plans | Chapter 6 |
| Fully Integrated Dual Advantage (FIDA) - Closed Effective 12/31/18 | Chapter 7 |
| Access to Care and Delivery System | Chapter 8 |
| Health Promotion and Care Management | Chapter 9 |
| Pharmacy Services | Chaper 10 |
| EmblemHealth Specialty Pharmacy Program | Chapter 11 |
| EmblemHealth Spine Surgery and Pain Management Therapies Program | Chapter 12 |
| Durable Medical Equipment | Chapter 13 |
| Home Health Care | Chapter 14 |
| SNF IRF LTAC | Chapter 15 |
| Medical Transportation Procedures | Chapter 16 |
| Utilization and Care Management | Chapter 17 |
| Clinical Practice Guidelines | Chapter 18 |
| Radiology Program | Chapter 19 |
| Radiology Privileging - Expired | Chapter 20 |
| Outpatient Diagnostic Imaging Privileging | Chapter 21 |
| Cardiology Imaging Program | Chapter 22 |
| Radiation Therapy Program | Chapter 23 |
| Chiropractic Program - Expired | Chapter 24 |
| Physical and Occupational Therapy Program - Expired | Chapter 25 |
| Behavioral Health Services | Chapter 26 |
| Vision Services | Chapter 27 |
| Quality Improvement | Chapter 28 |
| Medical Record Guidelines | Chapter 29 |
| Claims | Chapter 30 |
| Podiatry - Expired | Chapter 31 |
| Dispute Resolution for Commercial and CHP Plans | Chapter 32 |
| Dispute Resolution for Medicaid Managed Care Plans | Chapter 33 |
| Dispute Resolution for Medicare Plans | Chapter 34 |
| Regulatory Mandatory Reporting | Chapter 35 |
| Fraud and Abuse | Chapter 36 |
| Required Provisions to Network Provider Agreements | Chapter 37 |
| Glossary | Chapter 38 |
| Archives, Forms, Brochures & More ... | Chapter 39 |
