Switch to:

members
brokers
employers

Contact Us

Sign In

Portal Training Materials

Provider Newsletter

Join Our Network

Contact Us

members
brokers
employers

Search

test

Popular Tasks

Provider Toolkit
Provider Portal Help
Learning Online
Join our Network
Pharmacy
Find a Dental Specialist
Provider Newsletter
In the Community

Contact Us

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

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

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

Preauthorization List

Home
Home
Clinical Corner
UM and Medical Management
Preauthorization Lists
Preauthorization List

Download PDFDownload PDF

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:

Preauthorization Lists | Annual Review of Preauthorization Requirements – Scheduled Updates for July, September, and November 2022 | Preauthorization List Updates – Bariatric Surgery

Legal |
Legal Information |
Nondiscrimination Policy |
Accessibility Statement |
Privacy & Security Policy |
Stop Fraud |
Required Provisions

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

Enter your ZIP code:

Continue