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2022-2023 Annual Provider Notification

Switch to:

2022-2023 Annual Provider Notification

Group of doctors sitting at the table in the office and working.

What to Expect for 2023 & 2022 Year in Review

Our thanks to you, our partners, for the care you give our members. We appreciate your efforts and respect the time you take to provide quality care.

We are committed to identifying ways to reduce time spent on administrative transactions.* This year, we focused on improving the provider portal to simplify navigation and get you the information you need faster. Most recently, we added an easy Check Provider Network Status look-up tool for you to see if you are in-network for a member. We also added Care Plans for most members who participate in our Care/Case Management programs.

We started sending emails to let you know about key provider portal transactions and how they can make things easier for you. Be sure we have your email address so you can get these and other important updates. If you missed any, you’ll find links to the messages in the Your Resources section below. We will also post copies with our newsletters to make them easy to find. See the Clinical Corner section below for other provider portal improvements.

Please review and share the following materials with your clinicians and staff. This streamlined recap of 2022 guidance and what you’ll need to know for 2023 will help you care for your patients.

As always, visit our Provider Manual for guidance and reference on regulatory, policy, and accreditation requirements (such as provider rights, member rights and responsibilities, availability of criteria, and pharmacy procedures). Here are some of the most visited sections within the Provider Manual:

Information	Link
Credentialing Information	emblemhealth.com/providers/manual/credentialing
Member Rights and Responsibilities	emblemhealth.com/providers/manual/member-policies-andrights
Pharmaceutical Procedures	emblemhealth.com/providers/manual/pharmacy-services
Care Management	emblemhealth.com/providers/manual/care-management
Provider Portal	emblemhealth.com/providers/resources/provider-sign-in
Behavioral Health Services	emblemhealth.com/providers/manual/behavioral-health-services

*Members assigned to Montefiore CMO, HealthCare Partners, and SOMOS will continue to follow their administrative processes and will need to submit ER admission/newborn notifications directly to them. Our vendor partners who manage our Utilization Management Programs will continue to use their own websites and provider portals for transactions.

2023 Network and Benefit Plans

Our 2023 Summary of Companies, Lines of Business, Networks, and Benefit Plans is an extension of our provider agreement(s). It defines our 2023 offerings.

To easily see if you or a provider you conduct business for is in-network for a given member, use the Check Provider Network Status look-up tool in the “Eligibility” transaction’s “Member Details” page.

Refer to this list of 2023 Benefit Plans That Do Not Require a Referral when scheduling appointments so you do not spend time creating or searching for referrals that are not needed.

Select the links below to learn about our 2023 plans as well as key operational, training, and regulatory requirements. The links go to permanent webpages where you can view product-specific information all year long:

For your reference, also see:

EmblemHealth’s Current List of Network Labs

Improving the Patient Experience, Timely Access to Care, and Continuous Quality Improvement

At EmblemHealth, we value our members' experience with us and with you, our contracted providers. A member's experience often begins with their use of our provider directories. We ask you to keep your listings current. Once members have found the right provider, their next experience is appointment scheduling.

Members expect their providers to schedule timely appointments and to know whether services need referrals or preauthorizations.

They expect to be treated with dignity, in a culturally competent manner, free from discrimination, and to have their rights honored. We also expect our members to respect you and to honor their responsibilities. 

Health care professionals have the greatest impact on clinical outcomes. Those who follow established guidelines and best practices are successfully increasing quality measure scores and patient satisfaction. The following includes information to help you meet members' expectations and outlines the ways that we are measured in meeting them.

Easy Access Resources  

Continuous Quality Improvement 

We have adopted the Institute for Healthcare Improvement (IHI) and the Centers for Medicare & Medicaid Services (CMS) Triple-Aim for Healthcare Improvement. We strive to simultaneously improve the health status of our members, improve each member’s experience of care, and reduce the per capita cost of health care.

See our Provider Manual and new Quality Improvement page to learn more about our Quality Improvement Program. 

Behavioral Health: Mental Health & Substance Abuse

We partner with Carelon Behavioral Health (formerly Beacon Health Options) to provide and to manage mental health and substance use services. Members who have a Montefiore primary care provider (PCP), however, primarily utilize Montefiore University Behavioral Health as part of a special arrangement. To find a provider for your EmblemHealth members, use our Find a Doctor tool.

For full information about our mental health and substance use services available to your patients, see:

The Behavioral Health chapter of the EmblemHealth Provider Manual
The Behavorial Health and Substance Abuse page in Clinical Corner
Behavorial Health Clinical Practice Guidelines
Domestic Violence Guidelines
Children’s Medicaid Health and Behavioral Health System Transformation

Required Training for Mental Health & Substance Use Providers

The New York State Office of Mental Health (OMH), the Office of Alcoholism and Substance Abuse Services (OASAS), and the New York State Department of Health (NYSDOH) require EmblemHealth’s behavioral health providers to complete State-approved cultural competence training on an annual basis. To satisfy this requirement, providers must complete one of these two programs:

OASAS-approved training. See the NYS OASAS Training Catalog for a list of OASAS-approved trainers.
Two Uniform Network Provider Training modules. View these training modulesthrough the Center for Practice Innovations (CPI) Learning Community.

Claims Corner

Claims Corner

The Claims Corner section of our provider website is part of the EmblemHealth Provider Manual and houses Administrative Guidelines described in our participation agreements. Be sure to check the Claims Corner section of our provider website frequently for the latest updates. Here are the updates since December 2021 that you may have missed:

Payment Integrity Policies

To bring more transparency to how we process claims, we introduced three new payment integrity policies:

Coding Validation Payment Integrity Policy
EmblemHealth Payment Integrity Administrative Policy: Annual Fee Schedule Updates (CMS and Medicaid)
Sepsis Coding Criteria

Reimbursement Policies

We follow the correct coding rules established by the Centers for Disease Control and Prevention, American Medical Association, National Uniform Billing Committee, and Centers for Medicare & Medicaid Services for both professional and facility claims. Below is a summary of the substantive updates posted since December 2021, including two new policies that will go into effect in 2023:

New Reimbursement Policies

Computer-Assisted Surgical Navigation Policy (Commercial, Medicare, and Medicaid)
Durable Medical Equipment (DME) in Office / Non-Facility Place of Service (Commercial and Medicare)
Durable Medical Equipment (DME) Rental vs. Purchase (Commercial and Medicare)
Evaluation & Management (E&M) Services Policy 
Foot Care Services and Nail Debridement (Commercial, Medicare, and Medicaid) - Starts Jan. 1, 2023
From/To Date Span Policy, Facility and Professional (Commercial, Medicare, and Medicaid) - Starts Jan. 1, 2023
Home Health Care Services Reimbursement Policy - Starts Dec. 1, 2022
Intraoperative Neurophysiology Monitoring (IONM)
Laboratory/Venipuncture
No Cost/Reduced Cost Drugs, Implants, & Devices
Ophthalmology Reimbursement
Preventive Medicine & Screening – How to Effectively Use E&M Codes
Readmission Policy
Robotic Surgery
Telehealth/Virtual Care Services
Treatment Room
Unlisted Codes (existing policy documented in new format)

Revised Reimbursement Policies

Assistant at Surgery Modifiers 80/81/82 and AS (Commercial)
Coding Edits Policy
COVID-19 Testing Policy
COVID-19 Vaccine and Monoclonal Antibody Infusions Policy
EmblemHealth’s Coding Edits Policy 
Evaluation and Management (E&M) Services Reimbursement Policy
Modifier Reference Policy (Commercial)
Multiple Diagnostic Imaging Payment Reduction Policy (Commercial)
Preventive Care Services (Commercial)
Preventive Care Services (Medicare)
Prolonged Services

Retired Reimbursement Policy

In-Office Laboratory Services
Supplemental E&M Policy

Note: As of May 1, 2022, commercial and Medicare claims submitted with missing, invalid, or incomplete NDC or other information are being denied.

NPI & Taxonomy Codes

Sign in to your Provider/Practice Profile to make sure you have the right National Provider Identifier (NPI) and Taxonomy Code(s) on file.

EmblemHealth Risk Adjustment Program for Primary Care Providers

Together, EmblemHealth and Pulse8™ promote risk adjustment education and gap closure efforts for our New York State of Health (NYSOH) Marketplace, Medicare HMO, and Medicaid members. See the Pulse8 Risk Adjustment frequently asked questions.

Primary care providers (PCPs) are encouraged to take advantage of these additional compensation opportunities and Pulse8’s free monthly webinars. You may use telehealth/virtual care to close gaps in care.

No Cost Electronic Funds Program

ECHO Health, Inc. facilitates claims payments for EmblemHealth. Through ECHO, you can, at no cost, receive direct deposits to your bank account(s) (known as electronic funds transfer (EFT)) and view or download your remittances online (known as electronic remittance advantage (ERA)). Visit ECHO, click the “Click Here” button, and follow the instructions to enroll.

Clinical Corner

Clinical Corner

The Clinical Corner section of the EmblemHealth provider website is part of the EmblemHealth Provider Manual and houses Administrative Guidelines described in our participation agreements. This is where you will find:

Be sure to regularly check the Clinical Corner for the latest updates.

Here is a summary of the key updates posted this last year and those anticipated for 2023.

New In-House Post-Acute Care Process Coming

Before the end of 2022, EmblemHealth will begin to manage post-acute care (PAC) for EmblemHealth members, replacing eviCore. This includes home health care, skilled nursing facilities, acute rehabilitation, and long-term acute care hospital admissions.

Once we announce the start date, you will need to contact EmblemHealth to help arrange for PAC services and support. Note: eviCore will continue to handle durable medical equipment for EmblemHealth members.

Upcoming webinars: To help you better understand how the insourcing of all PAC services and the Transitions of Care program affects the members in your care, we will host a series of informational webinars. Please join the session that’s best suited for your facility/provider type – no registration required. All sessions will be held via Microsoft Teams between

Nov. 8 and Nov. 17, 2022. For the full list of session dates and times, visit emblemhealth.com/postacutecare.

Attention home health care providers: Our provider portal has a Home Health Status report to give you a consolidated view of the preauthorization requests for the members under your care. See the quick guide and video on our Portal Training page in the Preauthorization section for instructions on how to create the Home Health Status report.

Additional support: We offer a Transitions of Care program to help members with complex care issues better manage their health after a hospital admission. Our team will work with the member to make sure they are educated about their condition, have needed resources, and get the right care to feel better. Program information is available to our members on the Live Well section of our member website.

Referral Policy Updates

NEW FOR 2023 — We are removing referral requirements for our Medicaid, HARP, Child Health Plus, and Essential Plan members.

Until the COVID-19 State of Emergency ends, our Medicare members with plans that traditionally require referrals may continue to see specialists without referrals. When this changes, notice will be provided.

The “Do I need a referral?” - A Quick Guide has updated resources for 2023, including a video, to help providers understand when a referral is needed. Please review so you know whether a member needs a referral to see a specialist.

Preauthorization Requirements

Visit our EmblemHealth Preauthorization Lists page to see what requires preauthorization and who is responsible for the utilization review. Updates to the lists are posted in the Notable Changes section. The Preauthorization Check Tool returns information for all EmblemHealth and ConnectiCare members.

Use the Provider Portal for Preauthorization, Concurrent Review, Referral, and ER Admission/Notification Transactions

The provider portal makes coordination of care easier. Spend less time on the phone and feeding documents into a fax machine. By using the portal instead of faxes, you help us get started on your reviews sooner since the requests are legible. Upload documentation while creating a preauthorization request or afterwards by going back into the same preauthorization request to supplement the request and to provide concurrent review information.

New: Care Plans – Except for those with sensitive information, Care Plans developed through our Care/Case Management Programs are available through the Member Management section on the Eligibility Details screen. See Care Plans Training Guide and Video.

If you need help with these transactions or getting access to the portal, see these educational materials (guides and videos) and our Frequently Asked Questions webpage.

Care/Case Management Programs

EmblemHealth and Connecticare’s Care Management programs can assist providers by helping navigate our delivery systems and coordinate care across care settings to ensure our members can get the necessary care and resources in the right setting. To refer a member to one of our Care/Case Management programs:

EmblemHealth: See our Care Management Programs page for program descriptions, ways we can support you and your patients, and program-specific contact information. If you need general assistance, you can call 800-447-0768 Monday through Friday from 9 a.m. to 5 p.m.

ConnectiCare: Call 800-390-3522 Monday, Thursday, and Friday from 8 a.m. to 4 p.m. or Tuesday and Wednesday from 8 a.m. to 7:30 p.m.

Clinical Practice Guidelines

Four Clinical Practice Guidelines were updated in 2022:

Adult Preventive Services
Helicobacter Pylori
Hypertension
Pediatric Adolescent Preventive Services

We encourage our providers to consult EmblemHealth’s Clinical Practice Guidelines (CPGs) for assistance in the treatment of acute, chronic (e.g., HIV), and behavioral health issues.

Mandatory Reporting

To ensure public safety and track conditions affecting public health, the federal government, New York State, and New York City agencies have enacted laws that must be followed by health care professionals. Our network practitioners are required to participate in government reporting procedures and adhere to all rules, regulations, and codes. For a list of government agencies with required reporting, read the Regulatory Mandatory Reporting chapter of our online Provider Manual.

Medical Policy Updates

EmblemHealth’s Medical Policies are posted in Clinical Corner. Pharmacy Medical Policies are housed on the Enterprise Pharmacy Medical Policies and New Century Health—Medical Oncology Policies page.

Below, find the new and revised EmblemHealth medical policies published since December 2021 as well as those that have been retired. A similar list can be found in the ConnectiCare section of this annual notice regarding ConnectiCare’s Medical Policies.

New Medical Policies

Penile Implants

Revised Medical Policies

Bariatric Surgery
Blepharoplasty
BRCA 1 and 2 Genetic Testing
Cardiac Event Monitors
Gene Expression Profiling and Biomarker
Hyperbaric Oxygen Therapy
Lipoprotein Subclassification Testing for Screening, Evaluation, and Monitoring of Cardiovascular Disease
Medical Necessity Guidelines: Experimental, Investigational or Unproven Services
Non-Invasive Prenatal Testing (NIPT) for Fetal Aneuploidy
Obstructive Sleep Apnea Diagnosis and Treatment
Pain Management
Radiofrequency Ablation for Spinal Pain
Recurrent Pregnancy Loss
Site of Service Utilization
Testing for Breast Cancer

Retired Medical Policies

Bunion/Hammertoe/Metatarsophalangeal Joint
Functional Endoscopic Sinus Surgery (FESS)
Intrastromal Corneal Ring Segments
Noncoronary Vascular Stents
Prostatic Urethral Lift
Total Ankle Replacement
Transurethral Radiofrequency Micro-Remodeling for Female Stress Urinary Incontinence
Urine Drug/Alcohol Testing - Commercial/Medicaid (EH); was replaced by the enterprise-wide Reimbursement Policy for Drug and Alcohol Testing (Commercial/Medicaid)

Medical Technologies Database

Our Medical Technologies Database is routinely reviewed to ensure it is current. Dispositions apply to all lines of business unless otherwise indicated. This listing also captures annual procedure coding updates since December 2021.

ConnectiCare

ConnectiCare in 2023 & What You May Have Missed in 2022

Many EmblemHealth and ConnectiCare members have plans which give them access to providers in both organizations. Check the 2023 Summary of Companies, Lines of Business, Networks, and Benefit Plans to see which plans and networks offer reciprocity and view details on primary care provider (PCP) and referral requirements, out-of-network coverage, copays, and maximum out-of-pocket limits.

Sample ConnectiCare member ID cards may be found in the EmblemHealth Provider Manual.

For changes to ConnectiCare’s benefit plans and delivery system that could affect EmblemHealth providers treating ConnectiCare members, see ConnectiCare’s News and Updates and our Office Visit Newsletter.

Medical Policy Updates

ConnectiCare’s Medical Policies are posted on the Medical Coverage Criteria page. At the top of the page, select Commercial or Medicare to see the applicable policies. Below, find the new and revised medical policies published since December 2021, including a new policy starting January 1, 2023:

New Medical Policies

Acupuncture for Chronic Low Back Pain (Medicare)
Autologous Chondrocyte Implantation
Continuous Passive Motion Devices
Cosmetic and Reconstructive Surgery Procedures
Fecal Incontinence Treatment
Lipoprotein Subclassification Testing for Screening, Evaluation, and Monitoring of Cardiovascular Disease
Osteochondral Grafting
Penile Implants
Radiofrequency Ablation for Spinal Pain

Revised Medical Policies

Bariatric Surgery
Blepharoplasty
Cardiac Event Monitors
Hyperbaric Oxygen Therapy
Infertility (Commercial)
Non-Invasive Prenatal Testing (NIPT) for Fetal Aneuploidy
Obstructive Sleep Apnea Diagnosis and Treatment
Radiofrequency Ablation for Spinal Pain
Site of Service Utilization

Retired Medical Policies

Bunion/Hammertoe/Metatarsophalangeal Joint
Cosmetic Surgery Procedures
Drug and Alcohol Testing (Commercial) (CCI) was replaced by the enterprise-wide Reimbursement Policy for Drug and Alcohol Testing (Commercial/Medicaid)
Functional Endoscopic Sinus Surgery (FESS)
Intrastromal Corneal Ring Segments
Reconstructive Surgery
Total Ankle Replacement
Transurethral Radiofrequency Micro-Remodeling for Female Stress Urinary Incontinence

Payment Integrity Policies

To bring more transparency to how we process claims, we introduced two new payment integrity policies:

Coding Validation Payment Integrity Policy
Sepsis Coding Criteria

Reimbursement Policies

We follow the correct coding rules established by the Centers for Disease Control and Prevention, American Medical Association, National Uniform Billing Committee, and Centers for Medicare & Medicaid Services for both professional and facility claims. Below is a summary of the substantive updates posted since December 2021 including a new policy that will go into effect in 2023:

New Reimbursement Policies

Allergy Testing & Immunotherapy Policy
Computer-Assisted Surgical Navigation Policy (Commercial, Medicare, and Medicaid)
Durable Medical Equipment (DME) in Office / Non-Facility Place of Service (Commercial and Medicare)
Durable Medical Equipment (DME) Rental vs. Purchase (Commercial and Medicare)
Emergency Department (ED) Facility E&M Coding Reimbursement Policy (Commercial & Medicare) and Optum Emergency Department Claim (EDC) Analyzer tool™ 
Evaluation & Management Services (E&M) Policy 
Foot Care Services and Nail Debridement (Commercial, Medicare, and Medicaid) - Starts Jan. 1, 2023
Home Health Care Services Reimbursement Policy - Starts Dec. 1, 2022
No Cost/Reduced Cost Drugs, Implants & Devices
Ophthalmology Reimbursement
Preventive Medicine & Screening – How to Effectively Use E&M Codes
Readmission Policy 
Robotic Surgery Telehealth/Virtual Care Services
From/To Date Span Policy, Facility and Professional (Commercial, Medicare, and Medicaid) - Starts Jan. 1, 2023
Treatment Room
Unlisted Codes (existing policy documented in new format)

Revised Reimbursement Policies

ASC Grouper Policy (Commercial)
Assistant at Surgery Modifiers 80/81/82 and AS (Commercial)
Coding Edits Policy
Commercial Preventive Services List
COVID-19 Vaccine and Monoclonal Antibody Infusions Policy
Evaluation and Management (E&M) Services Reimbursement Policy (Commercial & Medicare) 
Medicare Preventive Grid
Modifier Reference Policy
Observation Stay (Medicare) 
Provider’s Guides to Preventive Health Services (Medicare)

Retired Reimbursement Policies

Supplemental E&M Policy

Note: As of May 1, 2022, Commercial and Medicare claims submitted with missing, invalid, or incomplete NDC or other information are being denied.

Learning Online: Required Training and Educational Opportunities for Medical Providers

The Learning Online section of our provider website is filled with required and recommended learning opportunities.

Here is a sampling of what you can find there:

Required Training for EmblemHealth Practitioners, Providers, and Vendors - Special Needs Plan (SNP) Model of Care (MOC) training for providers in the VIP Bold Network and Network Access Network
Required Medicare Training on Fraud, Waste, and Abuse
Cultural Competency Continuing Education and Resources
Health Literacy
Free Continuing Medical Education (CME) Activities Sponsored by Pri-Med
HIV/AIDS Education

Free Pulse8 Webinars for Patient Management and ICD-10 Coding

Pulse8 offers free webinars for patient management and ICD-10 coding. To register, go to pulse8.zoom.us and select the session that interests you. See our Learning Online page for the full schedule.

If you have questions or would like to set up a private session for your practice, please email ProviderEngagement@Pulse8.com or call their Customer Support team at 410-928-4218, ext 7. Their hours are Monday through Friday from 8 a.m. to 8 p.m.

Learn more about the Pulse8 Collabor8 risk adjustment program.

HIV/AIDS and Sexually Transmitted Diseases

Pri-Med offers courses such as “HIV update for the non-ID specialist: What every clinician needs to know” and “Pre-exposure prophylaxis for HIV Infection.” Just search for “HIV” to find them. You can manage your learning, track credits online, and complete activities at your own pace.

The New York State Department of Health, AIDS Institute has lead responsibility for coordinating state programs, services, and activities relating to HIV/AIDS, sexually transmitted diseases (STDs), and hepatitis C. For information on programs, initiatives and services, visit the AIDS Institute for training and resources to help your patients.

To refer a patient to the EmblemHealth HIV Case Management program, please call or have the member call 800-447-0768.

Pharmacy

To see announcements of formulary changes, see EmblemHealth’s 2023 Formulary Updates webpage. To determine whether a specific drug is covered by a member’s health plan, use the applicable formulary search:

Our Find a Network Pharmacy tools can help you and your members find a nearby participating pharmacy.

New Aug. 1, 2022: Commercial Plan Site of Service Coverage Rules for Maintenance Infusions

Starting Aug. 1, 2022, in support of our commitment to keeping members’ costs down, we changed how we cover ongoing maintenance infusion services for adults (21+) in our commercial plans for both EmblemHealth and ConnectiCare. Routine maintenance will be covered in the following outpatient settings:

Home (POS 12)
Office (POS 11)
Ambulatory infusion suites (POS 24, POS 49, or POS 12 with Modifier SS)

We will allow exceptions for initial doses and members with justifiable needs to continue care in a hospital outpatient setting. Authorizations from Express Scripts’ company Care Continuum given prior to Aug. 1, 2022, are being honored through the date noted in their approval letter. For full details, please see the Site of Service Medical Policy – Infusions and Injectables.

New York Cancer & Blood Specialists (NYCBS) – A Concierge Experience

To give our members a better alternative to infusions in the hospitals, EmblemHealth has collaborated with New York Cancer & Blood Specialists (NYCBS) to offer specialty office infusion services for benign and malignant conditions in NYCBS’ quiet, comfortable, spacious suites in convenient locations throughout the five boroughs and Long Island.

NYCBS has agree to provide EmblemHealth members with a concierge experience that includes:

Quick scheduling.
Extended hours, including weekends at some locations.
Amenities such as blankets and iPads.

For EmblemHealth-contracted providers and their office staff, NYCBS can offer:

Direct communication with NYCBS physicians to get up-to-date information on their patients’ treatment.
Access to the NYCBS coordinator who will obtain any required preauthorizations from EmblemHealth, significantly decreasing the administrative burden on your staff.

Coordinator: Michelle Sta. Cruz

Phone Number: 631-574-8303

Email Address: EmblemTreatments@nycancer.com

For help finding an optimal infusion setting for your patient, email us at HomeInfusionteam@emblemhealth.com.

Your Resources

For a list of frequently used phone numbers, addresses, and websites, see the Directory chapter of the EmblemHealth Provider Manual.

How Do I?

You can save time by checking Provider Help and Support page's compilation of frequently asked questions and answers before contacting Customer Service.

Provider Portal

Our provider portal is designed to be simple and intuitive. Should you need help, see these frequently asked questions, videos, and user guides to help you, step-by-step, through each transaction.

New in 2022

You can now:

See if a provider you conduct business for is in-network for a given member. Use the Check Provider Network Status look-up tool in the “Eligibility” transaction’s “Member Details” page.
View care plans created through our Care/Case Management programs and submit updates to, and inquiries about, the care plans to the Care Team.
Determine whether a provider falls under a delegated credentialing arrangement in the Provider Profile.
Experience improved site navigation, information displays, and printing options.

Upload Your Documents – Don’t Fax Them: We encourage you to take advantage of the provider portal to upload documents in support of your preauthorization requests, concurrent reviews, and discharge plans. To add more information, go into the original preauthorization request and use the upload documentation feature.

Portal Administrators: It’s important to us that our members’ protected health information (PHI) is always safe. Here are some good habits to adopt in protecting our members’ information:

Schedule time to periodically audit your portal users.
Deactivate portal accounts for staff* who have left your organization.
Make sure your staff is assigned to the Tax IDs, providers, and roles that match their job’s required access to conform with HIPAA’s “minimally necessary” standards.

*When a provider leaves our network, the provider portal account is automatically updated to a special inactive user status. They will be able to view information, but not submit new transactions. This means portal administrators only need to actively update non-provider staff user accounts for those who should not have portal access.

Miss any of our emails? Click the topics below to see what you may have missed:

June 2022

Your Time is Valuable, and Our Portal Can Save You Time

July 2022

Make Patient Management Simpler Through Our Secure Portal

August 2022

Billing Specialists: Use Our Portal to Simplify Accounts Receivables for EmblemHealth Members

September 2022

Billing Specialists: Need Explanations of Payments (EOPs)? Find Them on Our Provider Portal

October 2022

Provider Portal: New Way to See If a Provider Is In-Network for a Member

Provider Manual

The online Provider Manual is an extension of your EmblemHealth or ConnectiCare contract. It has information about your administrative responsibilities, contractual and regulatory obligations, and best practices for helping members navigate our delivery systems. Revisions are made as policies are renewed, new programs are introduced, and rules change.

EmblemHealth Neighborhood Care

EmblemHealth Neighborhood Care provides in-person customer support, access to community resources, and programming to help the community learn healthy behaviors. Members and non-members alike can visit Neighborhood Care and take advantage of our classes, tools, and face-to-face support. The health and wellness classes support the different dimensions of wellness, including physical, financial, social, and emotional. Neighborhood Care does not provide medical services. Instead, our role is to help practitioners manage patient care by supporting the practitioner-patient relationship.

Member Materials

This page offers materials you can give your members in support of your care plans.

Provider Toolkit

The Provider Toolkit has guides and quick references to help with the administration of our plans. The Toolkit is where we house welcome materials for new providers.

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Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.