On a daily basis, you may have questions about your patients' eligibility and benefits or need to access details on a particular claim submission. Having the ability to quickly locate that information can make the difference between a productive day and one fraught with frustration and stress. Here are some ways that you can connect with EmblemHealth:
1. Contact Us
The most efficient way to contact EmblemHealth is through our secure website at www.emblemhealth.com. Just sign in and go to our Message Center. Then click “Compose Message” and select the category that best matches your issue from the drop-down menu.
Another way to access information is to use our automated phone systems, which we recently updated so you can sign in with your TIN and conduct business for all our members and plans. For a complete list of Customer Service numbers, go to Contact Us.
2. Provider Resources
This underutilized tool offers an abundance of information at your fingertips:
- Provider Toolkit — Here you can access important forms (e.g., referral forms for EmblemHealth Neighborhood Care), formulary searches, HMO and PPO plan contact sheets, instructions on how to navigate our secure website, network laboratories, credentialing information, regulatory required provisions to network provider agreements and more.
- Medical Policies — Updated regularly, the Medical Policies section is a comprehensive list of documents that detail our medical guidelines so you can determine if a procedure is medically necessary. Medical policies are listed alphabetically for your convenience.
- Clinical Practice Guidelines — Have a question on what is and is not covered? Go to the Clinical Practice Guidelines section of Clinical Corner, where you’ll find evidenced-based recommendations on what is covered in our health benefit plans. Stay current on updates by checking this page regularly.
3. Provider Manual
Here you can find detailed information about your administrative responsibilities, contractual and regulatory obligations and best practices for interacting with our plans and helping your patients understand their coverage. You will also find information on our wellness programs, which foster disease prevention and healthier living.
Want to stay up to date on changes to our provider manual? Subscribe to the chapters and sections you use most often. You’ll receive an email notification each time we make an update.