Fully insured large and small groups and ASO clients have access to five of our largest networks.
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What is The Bridge Program?
Bridge is an innovative concept that gives our members access to a combination of our existing networks through our affiliated companies and partners.
Below are the five (5) networks that members may access.
If your practice has a contract with one of these networks, you can see Bridge Program members.
- EmblemHealth Insurance Company’s (formerly HIPIC) Prime Network
- EmblemHealth Plan Inc.’s (formerly GHI) National Network
- ConnectiCare, Inc.’s Choice Network
- QualCare Network
- First Health Network
See all plans offering Bridge in a comprehensive summary of companies, lines of business, networks, and benefit plans.
If you participate in any of these networks, you are an in-network provider for Bridge Program members. The Frequently Asked Questions section below details how to determine if you may see a member with Bridge access and how you will be paid.
Sample Member’s ID Card
See the Member ID Card chapter of the EmblemHealth Provider Manual for a description of the logos shown on samples of all Member ID Cards. If the card says “Bridge” as shown below, the member has access to all five networks shown above..
Sample ID Card for EmblemHealth
Sample ID Card for ConnectiCare
How to Read the Member’s ID Card
Check the bottom right corner of the back of your Member’s ID card to match the correct administrative processes to follow below and discover which rules apply. See links for Utilization Management and Claims below the chart.
How to Read the Member’s ID Card
Check the bottom right corner of the back of your Member’s ID card to match the correct administrative processes to follow and discover which rules apply. See links for Utilization Management and Claims below the chart for more guidance.
Member's ID Card
Utilization Management
Claims Information
Preauthorization lists and UM programs follow non-City of New York EmblemHealth Plan, Inc. (Commercial)
Payor IDs, submission addresses, and processing rules follow non-City of New York EmblemHealth Plan, Inc. (Commercial)
Preauthorization lists and UM programs follow EmblemHealth Insurance Company
Payor IDs, subission addresses, and processing rules follow EmblemHealth Insurance Company
Preauthorization lists and UM programs follow ASO Client's instructions
Payor IDs, submission addresses, and processing rules follow EmblemHealth Insurance Company
Preauthorization lists and UM programs follow ConnectiCare coverage guidelines
Payor IDs, Submission addresses, and processing rules follow ConnectiCare billing and claims guidelines
EmblemHealth
Utilization Management
Preauthorization lists and UM programs follow non-City of New Work EmblemHealth Plan, Inc. (Commercial)
Claims Information
Payor IDs, submission addresses, and processing rules follow non-City of New York EmblemHealth Plan, Inc. (Commercial)
Utilization Management
Preauthorization lists and UM programs follow EmblemHealth Insurance Company
Claims Information
Payor IDs, subission addresses, and processing rules follow EmblemHealth Insurance Company
Utilization Management
Preauthorization lists and UM programs follow ASO Client's instructions
Claims Information
Payor IDs, submission addresses, and processing rules follow EmblemHealth Insurance Company
Utilization Management
Preauthorization lists and UM programs follow ConnectiCare coverage guidelines
Claims Information
Payor IDs, Submission addresses, and processing rules follow ConnectiCare billing and claims guidelines
Frequently Asked Questions
Bridge Provider:
It means:
- Increasing the number of our members who may come to you for care.
- Ensuring your staff knows how to identify these new members who can see you.
- Following the underwriting company’s administrative guidelines.
- Sending members to their designated utilization management programs.
The simplest way to see if you are considered in-network for a member is to use the Check Network Status feature on the provider portal.
Here’s how:
- From the provider portal home page, select the Member Management tab.
- From the drop-down list, select Provider Network Status.
- In the Search By field drop-down, select either Member ID or Member Name. Member name search requires entering the First Name, Last Name, and Date of Birth.
- Click Search.
- Click Check Provider Network Status button in the main section at the top of the page.
- The member’s information will carry forward to a new screen where you can search for the provider in your practice.*
- The results will display the provider’s network status for that member in the right-most column in the table.
You are considered in-network for a member seeking care if you are part of any of the networks listed below and the word “Bridge” appears on the member’s ID card.
- EmblemHealth Insurance Company’s (formerly HIPIC) Prime Network
- EmblemHealth Plan Inc.’s (formerly GHI) National Network
- ConnectiCare, Inc.’s (CCI) Choice Network
- QualCare Network**
- First Health Network**
Look to the branding and instructions on the member’s ID Card. ID card will have “Bridge” in the network field and ConnectiCare, QualCare, and First Health logos.
* Portal user must be authorized to conduct business for the provider they are looking up.
** EmblemHealth and its affiliate ConnectiCare Insurance Company, Inc. partner with QualCare and First Health to provide coverage for certain of our benefit plans beyond our own contracted networks’ geographic coverage. These extended networks are considered in-network, based on their geography, for our members with the Bridge Program as follows:
QualCare = New Jersey Only
First Health Network = All States except:
- Connecticut
- Massachusetts’s 4 Counties (Berkshire, Hampden, Hampshire, and Franklin)
- New Jersey
- New York’s 28 Counties (Albany, Bronx, Broome, Columbia, Delaware, Dutchess, Fulton, Greene, Kings, Montgomery, Nassau, New York, Orange, Otsego, Putnam, Queens, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Schoharie, Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)
JP 62315 6/2023
Payment:
Members whose coverage is part of our Bridge Program have access to providers in many of our networks. Providers are paid according to their contracts with our company. The chart below sets the guidelines for determining how Bridge Program claims are reimbursed:
How we pay Bridge Program claims |
|
If you have a contract with the following plans (first applicable contracted plan applies to all Bridge Program claims) |
You will be paid these rates |
Health Insurance Plan of Greater New York (HIP)1 |
Health Insurance Plan of Greater New York - HMO |
EmblemHealth Insurance Company fka HIP Insurance Company of New York (HIPIC) |
EmblemHealth Insurance Company |
EmblemHealth Plan, Inc. |
EmblemHealth Plan, Inc. |
ConnectiCare only |
ConnectiCare |
QualCare only |
QualCare |
First Health only |
First Health |
If you still have questions or concerns about which contract rate applies, contact us at 866-447-9717, Monday through Friday, from 8 a.m. to 6 p.m., and a Customer Service agent will assist you.
1To the extent that you contract with HIP, the HIP rates will always apply to Bridge Program claims, regardless of whether you are contracted with any other EmblemHealth entity.
You follow the same billing protocols as you would for any other member falling under a given underwriting company and their applicable vendor partnerships.
See EmblemHealth Claims Contacts.
See ConnectiCare BIlling and claims information.
Utilization Management:
Referrals are not required. Follow the Utilization Management rules for the underwriting company found on the back of the Member’s ID Card.
See Who To Contact for EmblemHealth Preauthorization.
See Who To Contact for ConnectiCare Coverage guidelines.
Fully insured members follow all the standard administrative guidelines as every other member with the same benefit plan underwritten by the same company. This includes using the same preauthorization lists, preauthorization contacts, and special vendor managed utilization management programs.
The Bridge ASO program was initially launched with the goal of having all Bridge ASO members follow EmblemHealth Insurance Company’s standard utilization management rules. However, based on client request, we have given ASO clients the option to customize their utilization management rules. They may adopt an existing standard set of rules, or they may choose to develop their own.
