Certain benefit plans* require a referral to process and pay specialists' claims. Submitting a claim with the UPIN and NPI in place of a referral is not acceptable. We ask that specialists verify that the required referral has been issued by signing in to www.emblemhealth.com. Then select "Referrals" on the left-hand navigation bar, followed by "Search Referrals."
Claims submitted without the requisite referral on file will be automatically denied for noncompliance. Please note: A practitioner NPI may also be required in fields 2010AA, 2010AB, 2310B and 2420A of an electronic claim.
*With the exception of HIP EPO/PPO, HIP Access I/II and HIP VIP Plus plans, HIP benefit plans require a referral to process and pay specialists' claims.