Provider Manual | EmblemHealth

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Online Provider Manual

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.


**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
2023 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     Chaper 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
Utilization and Care Management     Chapter 17
Clinical Practice Guidelines Chapter 18
Radiology Program     Chapter 19
Radiology Privileging  - Expired Chapter 20
Outpatient Diagnostic Imaging Privileging     Chapter 21
Cardiology Imaging Program     Chapter 22
Radiation Therapy Program     Chapter 23
Chiropractic Program - Expired     Chapter 24
Physical and Occupational Therapy Program - Expired Chapter 25
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