Empire BlueCross BlueShield to perform claim review for NYC members


Date Issued: 11/9/2017

Beginning on December 15, 2017, Empire BlueCross BlueShield (EBCBS) will perform post-service reviews for City of New York members enrolled in our GHI CBP plan.

This means when EmblemHealth receives a claim for a service that requires precertification, but we haven't received a precertification, we will ask the rendering provider to send the member's medical records to Empire BlueCross BlueShield. They will review the records and determine how to process the claim.

The provider will be asked to send the requested documentation to:

Empire BlueCross BlueShield
Medical Records Library, 2C
P.O. Box 11810
Albany, NY 12211-0810

If Empire Blue Cross Blue Shield does not receive the requested information within 45 days, a determination will be made based on the information available.

For additional information about how to submit clinical information to Empire BlueCross BlueShield using the Clinical Data Submission Tools, please see the Forms and Quick Guides section at https://empireblue.com/home-providers.html.