Adult Comprehensive Health Assessment Provider Incentive Program

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Adult Comprehensive Health Assessment Provider Incentive Program

EmblemHealth is pleased to announce a new incentive opportunity for providers who do not participate in other EmblemHealth value-based arrangements. This new program offers a unique opportunity to help close your patients’ gaps in care while increasing your revenue and meeting your important quality benchmarks. If you meet this criteria, join us in making the commitment to help our members stay healthy, get well, and lead better lives.

This progam requires a completed Adult Comprehensive Health Assessment Form submission to EmblemHealth for each of your eligible patients. A $50 payment will be made to you/your practice for each successful submission meeting the standards below.  We will evaluate the functioning of this program at the end of the calendar year to determine if and how we move forward in 2023 and beyond.


  • Only active EmblemHealth Medicare, Medicaid, and Essential Plan members, 18 years or older, are eligible for this program.
  • Providers participating in other EmblemHealth value-based arrangements are not eligible for this program.

Form Completion and Submission

  • The Adult Comprehensive Health Assessment Form must be completed, signed, and returned to EmblemHealth by Dec. 31, 2022.
  • The Form may only be submitted once per eligible member, per calendar year and must include information from recent 2022 visits (traditionally annual well-visits) that are documented in the eligible member’s medical record.
  • Fax completed Form/s to 212-510-5936.

Payment Contingencies:

  • The Adult Comprehensive Health Assessment Form should be populated with results using the most up-to-date preventive care screening information where applicable or if the results are not available, indicate that you have no record of it. Incomplete forms may result in delayed or nonpayment.
  • The NPI and TIN fields on the form MUST be filled out to receive payment.
    • If you are working in multiple locations (have multiple TINs), you must use the address where the member was serviced to bill claims for that visit.
    • Payments will be made quarterly based on TIN provided on the assessment form.
  • Payments will be made using the same method on file for claims payments made to the associated TIN.

Questions and Assistance

If you would like to receive a target member list for this initiative, please email us at

Thank you for your partnership. 

09/2022 JP 58310