Online Provider Manual

This manual applies to all EmblemHealth, GHI, HIP and Vytra plans, and it replaces all provider manuals published before November 2009. It includes detailed information about your administrative responsibilities, contractual and regulatory obligations, and best practices for interacting with our plans and helping our members navigate our delivery systems.

You can browse the online manual using the table of contents below or click the button to download a copy.

**However, please note that the online manual consists of the most up-to-date information.

Overview Chapter 1
Directory Chapter 2
Credentialing Chapter 3
Member Identification Cards     Chapter 4
Member Policies and Rights     Chapter 5
2019 Provider Networks and Member Benefit Plans     Chapter 6
Fully Integrated Dual Advantage (FIDA) - Closed Effective 12/31/18     Chapter 7
Access to Care and Delivery System Chapter 8
Health Promotion and Care Management     Chapter 9
Pharmacy Services     Chapter 10
EmblemHealth Specialty Pharmacy Program  Chapter 11
EmblemHealth Spine Surgery and Pain Management Therapies Program     Chapter 12
Durable Medical Equipment     Chapter 13
Home Health Care     Chapter 14
SNF IRF LTAC Chapter 15
Medical Transportation Procedures     Chapter 16
Care Management     Chapter 17
Clinical Practice Guidelines     Chapter 18
Radiology Program     Chapter 19
Radiology Privileging     Chapter 20
HIP Outpatient Diagnostic Imaging Referral Payment Policy     Chapter 21
Cardiology Imaging Program     Chapter 22
Radiation Therapy Program     Chapter 23
Chiropractic Program     Chapter 24
Physical and Occupational Therapy Program Chapter 25
Behavioral Health Services     Chapter 26
Vision Services     Chapter 27
Quality Improvement     Chapter 28
Medical Record Guidelines     Chapter 29
Claims     Chapter 30
Podiatry     Chapter 31
Dispute Resolution for Commercial and CHP Plans     Chapter 32
Dispute Resolution for Medicaid Managed Care Plans Chapter 33
Dispute Resolution for Medicare Plans Chapter 34
Regulatory Mandatory Reporting Chapter 35
Fraud and Abuse Chapter 36
Required Provisions to Network Provider Agreements Chapter 37
Glossary Chapter 38
Forms, Brochures & More ... Chapter 39