Your practice information appears in our network directories, including our online Find a Doctor tool. Keeping your information updated helps patients and physicians 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
- Current and valid state (NJ, NY, CT, MA) licenses
- DEA or CDS certificate
- Email address
- Fax number
- Hospital affiliations
- NYS Patient-Centered Medical Home (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
- Taxonomy codes
- Wheelchair accessibility at a practice location
Providers and their staff can sign in to emblemhealth.com/providers to update their practice records under the Provider Profile tab 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 no later than five business days after any change to office address, telephone number, office hours, specialty, languages spoken, hospital affiliation, or addition/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.
Providers in our Enhanced Care Prime Network for Medicaid, HARP, and Essential Plans, must notify the New York State Department of Health of any change of address, telephone number, or other pertinent information within 15 days of the change. To update provider addresses and telephone information, providers must complete their designated Change of Address form. Each Change of Address form contains detailed instructions for submission based on provider type and license/registration address.
With respect to participation in Federal Employees Health Benefits (FEHB), providers and facilities must have in place business processes to ensure the timely provision of provider directory information to EmblemHealth:
- when the provider or facility begins a network agreement with EmblemHealth,
- when the provider or facility terminates a network agreement with EmblemHealth,
- when there are material changes to the content of provider directory information,
- upon request by EmblemHealth and
- at any other time determined appropriate by the provider, facility or U.S. Department of Health and Human Services.
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 online Find a Doctor 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 2021 Summary of Companies, Lines of Business, Networks and Benefit Plans and the 2022 Summary of Companies, Lines of Business, Networks and Benefit Plans in our Toolkit for a listing of all networks and plans.
Digital representations of our most common member ID cards are located in the Member Identification Cards 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 inpatient stay for basic plan information. Providers should also verify member eligibility by signing in to emblemhealth.com/providers and using the Eligibility drop-down under the Member Management tab. A member ID card does not guarantee eligibility or payment.