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Our goal is to make it easier for you to do what you do best - take care of patients.
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Our Provider Manual has what you need to know about our plans, policies and procedures.
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Providing fast, accurate claim payments is how we take better care of our health care professionals.
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Learn about EmblemHealth’s pharmacy benefits.
Effective April 2015:
2008 Standards (PPC-PCMH)
Effective January 2016
Payment is calculated by multiplying the level achieved in the NCQA recognition program by the number of Medicaid, HARP and Child Health Plus patients who have selected the eligible practitioner as their primary care physician (panel size). Payment from EmblemHealth is based on the number of HIP Medicaid, HARP and Child Health Plus members on your practice panel.
Once the issue is identified and a resolution found, the adjusted payment will be made in the month following the end of the quarter in which the inaccuracy was discovered.
Additional questions about this initiative may be directed to New York State at the number noted above.
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