Switch to:
  • members
  • brokers
  • employers
  • Contact Us
EmblemHealth Logo.
EmbelmHealth Logo

Sign In

Sign In

Portal Training Materials

Provider Newsletter

Join Our Network

  • EmblemHealth Logo
  • Provider Resources
    • Key Resources/Provider Toolkit
    Provider Resources
    Key Resources/Provider Toolkit Request Provider Portal Account Our Companies, Lines of Business, Networks, and Benefit Plans Frequently Asked Questions Welcome materials, guides, and forms News and Updates Newsletters CAHPS Tips
    Connect Members to Care Access & Availability Standards Plans with No Referrals Referral Quick Guide Network Laboratories Urgent Care Center Locations Mental Health (Carelon) Find Care, search all in-network providers/facilities
    Learning Online/Required Trainings Find videos and guides
    Join Our Network Credentialing Forms and Information
  • Clinical Corner
    • UM and Medical Management
    • Care Management Programs
    Clinical Corner
    UM and Medical Management Preauthorization Lists Preauthorization Contacts
    Care Management Programs Help for patients with chronic or complex conditions
    Vendor-Managed Utilization Management Programs Behavioral Health Services
    Quality Improvement Programs and Resources Clinical Practice Guidelines
    Medical Policies Guidelines we follow
    Pharmacy Pharmacy Initiatives
    Provider quality improvement rubbon

    Quality Improvement

    Find our Quality Improvement programs and resources here.

    Search Our Quality Improvement Page
  • Claims Corner
    • Claims Resources
    Claims Corner
    Claims Resources Fee Schedule Updates Hospital Readmission Policy Electronic Claims Policy In-Office Testing List
    Submissions Claims Contacts EmblemHealth Guide for Electronic Claims Submissions Timely Submissions Claims Submissions
    Reimbursement Policies Consolidated Appropriations Act/No Surprise Billing Information Payment processes unique to our health plans
    Payment Integrity Policies How we pursue payment accuracy
    Coding EmblemHealth Guide for NPIs and Taxonomy Codes
  • Provider Manual
    Provider Manual
    Overview Directory Credentialing Member Identification Cards Member Policies and Rights Provider Networks and Member Benefit Plans
    Access to Care and Delivery System Health Promotion and Care Management Pharmacy Services EmblemHealth Spine Surgery and Pain Management Therapies Program Durable Medical Equipment Home Health Care
    SNF IRF LTAC Medical Transportation Procedures Utilization and Care Management Clinical Practice Guidelines Radiology Program Outpatient Diagnostic Imaging Privileging View All
    Provider manual

    Provider Manual

    Find the specific content you are looking for from our extensive Provider Manual.

    Search the Provider Manual
  • Dental Corner
    • Resources for Dental Providers
    Dental Corner
    Resources for Dental Providers Benefits to Participation in Dental Network Join Our Dental Networks
    Welcome Dental Providers Find a Dentist
    Dentists Contact Us Update Your Practice Records
  • Sign In
  • Member Site
  • Broker Site
  • Employer Site
Contact Us

Search

    Popular Tasks

    • Provider Toolkit
    • Provider Portal Help
    • Learning Online
    • Join our Network
    • Pharmacy
    • Find a Dental Specialist
    • Provider Newsletter
    • In the Community
    Contact Us
    • EmblemHealth Logo
    • Provider Resources
      • Key Resources/Provider Toolkit
      Provider Resources
      Key Resources/Provider Toolkit Request Provider Portal Account Our Companies, Lines of Business, Networks, and Benefit Plans Frequently Asked Questions Welcome materials, guides, and forms News and Updates Newsletters CAHPS Tips
      Connect Members to Care Access & Availability Standards Plans with No Referrals Referral Quick Guide Network Laboratories Urgent Care Center Locations Mental Health (Carelon) Find Care, search all in-network providers/facilities
      Learning Online/Required Trainings Find videos and guides Join Our Network Credentialing Forms and Information
    • Clinical Corner
      • UM and Medical Management
      • Care Management Programs
      Clinical Corner
      UM and Medical Management Preauthorization Lists Preauthorization Contacts Care Management Programs Help for patients with chronic or complex conditions
      Vendor-Managed Utilization Management Programs Behavioral Health Services Quality Improvement Programs and Resources Clinical Practice Guidelines
      Medical Policies Guidelines we follow Pharmacy Pharmacy Initiatives
      Provider quality improvement rubbon

      Quality Improvement

      Find our Quality Improvement programs and resources here.

      Search Our Quality Improvement Page
    • Claims Corner
      • Claims Resources
      Claims Corner
      Claims Resources Fee Schedule Updates Hospital Readmission Policy Electronic Claims Policy In-Office Testing List
      Submissions Claims Contacts EmblemHealth Guide for Electronic Claims Submissions Timely Submissions Claims Submissions
      Reimbursement Policies Consolidated Appropriations Act/No Surprise Billing Information Payment processes unique to our health plans Payment Integrity Policies How we pursue payment accuracy
      Coding EmblemHealth Guide for NPIs and Taxonomy Codes
    • Provider Manual
      Provider Manual
      Overview Directory Credentialing Member Identification Cards Member Policies and Rights Provider Networks and Member Benefit Plans
      Access to Care and Delivery System Health Promotion and Care Management Pharmacy Services EmblemHealth Spine Surgery and Pain Management Therapies Program Durable Medical Equipment Home Health Care
      SNF IRF LTAC Medical Transportation Procedures Utilization and Care Management Clinical Practice Guidelines Radiology Program Outpatient Diagnostic Imaging Privileging View All
      Provider manual

      Provider Manual

      Find the specific content you are looking for from our extensive Provider Manual.

      Search the Provider Manual
    • Dental Corner
      • Resources for Dental Providers
      Dental Corner
      Resources for Dental Providers Benefits to Participation in Dental Network Join Our Dental Networks
      Welcome Dental Providers Find a Dentist
      Dentists Contact Us Update Your Practice Records
    • Sign In

    Policy

    01/02/2020
    1. Home
    2. Home
    3. Claims Corner
    4. Policies & Procedures
    5. Policy

    Last Reviewed: 10/23/2020

    Date Issued

    Title

    10/25/19 Infertility Coverage Expansion for HIP Medicaid and Commercial Members

    11/3/2016 Important Information about Lidoderm/Lidocaine 5% Patch Requests

    2/2/2016 Surprise Bills and Emergency Services Uniform Notice for Out of Network Providers

    11/22/2012 Look Back Periods to Reconcile Overpayments

     

    • Provider Portal
    • Sign In
    • Training Material
    • New Account Request Form
    • Portal FAQs
    • Quick Links
    • Join Our Network
    • Office Visit Newsletter
    • Learning and Required Trainings
    • Provider Toolkit
    • Member ID Cards
    • Member Materials
    • Careers
    • Family of Companies
    • Summary of Companies
    • Neighborhood Care
    • AdvantageCare Physicians
    • Support
    • Contact Us
    • FAQs
    • Language Assistance
    Also of Interest: 
    Audits Involving Medicare Demand Billing and Overpayments Involving Dual Eligible Recipients   |   Important Information about Lidoderm/Lidocaine 5% Patch Requests   |   Reminder of DMEPOS Costs for Medicaid Members Residing in Nursing Homes
    • Legal   |  
    • Legal Information   |  
    • Nondiscrimination Policy   |  
    • Accessibility Statement   |  
    • Privacy & Security Policy   |  
    • Stop Fraud   |  
    • Required Provisions

    ©2025 EmblemHealth. All Rights Reserved.

    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.

    Provider Portal
    • facebook
    • instagram
    • linkedin
    • twitter
    • youtube

    Enter your ZIP code:
    Continue