Your practice information appears in our network directories (including our online Find a Doctor tool) and is used in claims processing. Keeping your informatio nupdated helps patients find your practice and helps us accurately process your claims. You must report updates to your practice information if any of the following changes occur:
- Ability to accept new members
- Age-range limitations applicable to the health care professional
- Add or delete a provider from your practice
- Board certifications
- Change in current and valid state (NJ, NY, CT, MA) licenses
- Change in DEA or CDS certificate
- Email address
- Fax number
- Hospital affiliations
- NYS PCMH or NCQA PCMH certifications
- IRS taxpayer identification number (TIN)
- Languages spoken by you or within your office
- Medicaid number is assigned
- Medical group affiliation
- Medicare number is assigned
- National Provider Identifier (NPI) number is assigned
- OB/GYN opts to see GYN-only patients
- Office hours
- Opening or closing a primary care panel
- Practice addresses
- Practice phone numbers used for scheduling patient appointments
- Billing information
- Wheelchair accessibility at a practice location
Providers and their staff can sign in to update their practice records at emblemhealth.com/providers unless the provider is part of a group with arrangements to send changes via a spreadsheet/dataset process. For changes that cannot be processed online, mail or fax your changes to EmblemHealth’s Provider Modifications team:
Provider Modifications Team EmblemHealth
55 Water Street, 6th Floor
New York, New York, 10041-8190
Providers must inform EmblemHealth within five (5) business days, or as soon as possible, after any change to office address, telephone number, office hours, specialty, languages spoken, hospital affiliation, or addition or termination of an individual provider in a medical group. Updates to your practice information will be posted to the EmblemHealth website within 15 days. Some updates, such as to your license number, specialty or school, will be verified by our Credentialing department and may take longer to appear.
Note: Removing an individual provider from a service location does not affect previously submitted claims. EmblemHealth processes claims for a location with a Date of Service on or before the provider’s termination date.
EmblemHealth may terminate a provider if he/she fails to notify EmblemHealth of any required changes in a timely manner (subject to any applicable reconsideration or hearing rights required by state or federal law).
From time to time, regulatory agencies will audit EmblemHealth’s directories for accuracy and may impose fines and/or penalties for inaccurate information. Any fines/penalties or negative financial impact incurred by EmblemHealth due to a practitioner’s failure to notify us of any required change listed above are charged to the practitioner in an amount equal to the fine/penalty.
Change of Ownership
A change of ownership cannot be performed online; it is treated like a new enrollment. Providers must contact EmblemHealth when a change in ownership occurs. The appropriate contact information is located in the EmblemHealth Contact Information section of the Directory chapter.
Know Your Network Participation
The provider profile at emblemhealth.com/providers lists your network affiliations. We recommend you periodically review the information we have on file for you. We also encourage you to regularly share your network participation and any changes with your staff. If the network information on the member's ID card matches your network affiliations, then you are in-network for the member's benefit plan. See the Provider Networks and Member Benefit Plans chapter for a listing of all networks and plans.
Digital representations of our most common member ID cards are located in the Member Identification Cards section of the Your Plan Members chapter. Note: Some government program cards don’t have network names; however, they are easily identified by the plan name.
Ask to see a member’s ID card at each appointment, emergency visit, or inpatien tstay. However, the provision of services hould not be conditioned solely on the presentation of a member ID card because a member’s enrollment status can change due to various reasons. Sign in to emblemhealth.com/providers to check your patient’s eligibility status.