Clinical Corner

Clinical Corner is a resource for practice guidance related to the treatment of acute, chronic and behavioral health issues as well as the medical appropriateness of specific intervention. Click on any subject of interest to access information on that topic.

Utilization & Medical Management

EmblemHealth is simplifying our utilization management (UM) rules. We are reducing your need to seek pre-authorization (PA) based on the member’s type of plan (Commercial, Medicaid and Medicare) and the selected site of service.

Medical Policies

Clinical review criteria to determine medical necessity.

Dental

Find all you need to know about our dental plans and networks, including our policies on claims and X-ray submissions, predeterminations, standard exclusions and limitations, and coordination of benefits.

Behavioral Health

Caring for your patients with behavioral health issues is important to their overall health. We are here to help you understand and address their health care needs.

Additional information

Learn about manadatory e-prescribing

EmblemHealth partners with Express Scripts to manage electronic prescriptions for our members.

E-prescribing is convenient, fast and secure and is mandated by the New York State Department of Health.

It helps you as the provider by eliminating the need to handwrite most prescriptions. It also reduces paperwork, faxes and follow-up phone calls. For more information about e-prescribing, contact Express Scripts at:

Phone: 800-411-1665