This manual applies to all EmblemHealth plans and is an extension of your Provider Agreement. It includes detailed information about your administrative responsibilities, and contractual and regulatory obligations. It also details best practices for interacting with our plans and helping our members navigate their health care.

 

For EmblemHealth's clinical practice guidelines, click here.

 

**The online manual is updated regularly. Please do not refer to any previously downloaded PDF.

Overview Chapter 1
Directory Chapter 2
Credentialing Chapter 3
Member Identification Cards     Chapter 4
Member Policies and Rights  
Chapter 5
2021 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     Clinical Corner
EmblemHealth Specialty Pharmacy Program  Clinical Corner
EmblemHealth Spine Surgery and Pain Management Therapies Program     Chapter 12
Durable Medical Equipment Clinical Corner
Home Health Care     Clinical Corner
SNF IRF LTAC Clinical Corner
Medical Transportation Procedures     Chapter 16
Utilization and Care Management     Chapter 17
Clinical Practice Guidelines Chapter 18
Radiology Program     Clinical Corner
Radiology Privileging  - Expired Chapter 20
Outpatient Diagnostic Imaging Privileging     Clinical Corner
Cardiology Imaging Program     Clinical Corner
Radiation Therapy Program     Clinical Corner
Chiropractic Program     Clinical Corner
Physical and Occupational Therapy Program Clinical Corner
Behavioral Health Services     Chapter 26
Vision Services     Chapter 27
Quality Improvement     Chapter 28
Medical Record Guidelines     Chapter 29
Claims     Chapter 30
Podiatry  - Expired 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
Archives, Forms, Brochures & More ... Chapter 39