Switch to:
members
brokers
employers
Sign in
Contact Us
Navigation Open
close menu
Provider
Switch to:
provider
Switch to:
members
brokers
employers
Provider Resources
Clinical Corner
Claims Corner
Provider Manual
Sign in
Contact Us
Sign In
Search
Search
Search
test
Submit
Popular Tasks
Find a seminar or webinar
Claims information
View provider manual
Clinical guidelines
Provider portal
Contact Us
Neighborhood Care
Provider Resources
Provider Toolkit
New York Medicaid’s Statewide Patient–Centered Medical Home Incentive Program Practitioner Quick Reference
Preventive Health Guidelines
New Benefits for Medicaid-Eligible Children
Mental Health Checkups for Adolescents
Domestic Abuse Guidelines for Health Care Professionals
Urgent Care Center Locations
Occupational Health Clinic Joins EmblemHealth
PNC Remittance Advantage
HEDIS/QARR Medical Record Review and Clinical Data Collection
Go to
Join Our Network
Learning Online
Forms and Documents
Provider Newsletters
How Do I...
Member Materials
Medicaid, HARP, and CHPlus (State-Sponsored Programs)
Go to Provider Resources
Clinical Corner
UM and Medical Management
Utilization
Important Change to Injectable Drug List
No referrals needed for initial evaluation of PT, OT, and radiology
2020 Infertility Mandate PA Coding
Utilization Management Preauthorization Codes Removed Jan. 1, 2020
EmblemHealth Reduces Preauthorization Requirements
EmblemHealth Utilization Management Preauthorization List 1/1/2020 HIP & GHI PPO Non-City of New York
Go to
Medical Policies
Dental Providers
Benefit From Network Participation
Corrections to Preferred Dental Fee Increases
Join Our Dental Networks
Go to
Behavioral Health
Behavioral Health Clinical Practice Guidelines
Adult Preventive Services
Drug Safety Communications (Q2 & Q3 2017)
Go to
Go to Clinical Corner
Claims Corner
Benefits
Covering Medical Nutrition Therapy
EmblemHealth Coverage of Manual and Electric Breast Pumps
HPV Vaccine Covered for Girls and Boys
Medicaid Expansion of Coverage for Physical Therapy
Point of Pick up ZIP Code Required for Medicare Advantage Ambulance Claims
Revised Copayment Schedule for HIP Prime POS City of New York Benefit Plans
Skilled Care for Medicare Members
Vaccines for Children (VFC) Program
Medicaid Coverage Change for Child Annual Wellness Visits
Go to
Policies & Procedures
Policy
Prior Authorization for Some Medications Changing in 2019
Go to
Audits Involving Medicare Demand Billing and Overpayments Involving Dual Eligible Recipients
Claims Review Software
CMS has issued a new rule for Part D drugs
Costs Connected with Cosmetic Surgery Are Not Covered
Coverage Denied for Never Events Updated Information
EmblemHealth Coverage for Nurse Practitioner Services
EmblemHealth Coverage for Physician Assistant Services
EmblemHealth Preventive Care Screening Services Coverage
Go to
Coding
2014 CMS-HCC Model Changes
2017 ClaimsXten Edits
Abdominal Ultrasound for Mononucleosis
Additions to the Self-Referral Payment Policy List
Allergy Testing
Anesthesia for Pain Management Injections – Commercial (Updated)
Anesthesia Modifier Reporting
APG Rate Codes
Assistant Surgeon Reimbursement Policy
Go to
Submissions
Submitting Claims with Gender/Procedure Conflict
Claims Submission - Timely Filing
Claims Submission Changes for Radiologists Treating ACPNY Members
Home Health Billing Guide
Do Not Balance Bill Dual-Eligible Members
New Claims Submission Address for Behavioral Health
Submitting Corrected Claims
Submitting Claims for Non Credentialed Practitioner in a Group Arrangement
Submitting Corrected Paper Claims
Go to
Go to Claims Corner
Provider Manual
Home
Clinical Corner
UM and Medical Management
Utilization
Utilization
08/01/2019
Your safety and health are our top priority. Stay up to date on coronavirus (COVID-19)
here.
