Provider Manual

Chapter 2: Directory

This chapter contains contact information for parties within EmblemHealth, our delegated relationships and other external resources.

 

EmblemHealth
55 Water Street
New York, NY 10041-8190

Customer Service is available seven days a week (excluding major holidays), 8 am to 8 pm. Teletypewriter (TTY/TDD) services can be reached by calling 711.

Company Provider Network Customer Service
(Members)
Provider Customer Website
GHI Commercial:
CBP, National & Tristate Networks

Network Access Network
NYC: 
1-212-501-4444
Outside NYC: 
1-800-624-2414
NYC:
1-212-501-4444 
Outside NYC:
1-800-624-2414
Sign in to 
emblemhealth.com
and use the Message Center
Medicare:
Medicare Choice PPO Network
1-866-557-7300 1-866-557-7300
HIP/
HIPIC
Commercial:
Prime Network
1-800-447-8255 1-866-447-9717
Prime Network 1-877-244-4466
Select Care Network  1-888-447-7703
State Sponsored Programs: 
Enhanced Care Prime Network
(Including Child Health Plus)
1-855-283-2146
Medicare: 
VIP Prime Network
1-877-344-7364

For Claims Contacts please go here

All providers must verify member eligibility and benefits prior to rendering non-emergency services.

How to Obtain Prior Approval
Plan/Managing Entity Instructions

HIP

Requests may be submitted via the secure provider website: www.emblemhealth.com/providers, or faxed (866) 215-2928.

Call (866) 447-9717 for more information or to use the IVR system.

Hospitals and skilled nursing facilities can verify prior approval status by reviewing their concurrent review status reports.

EmblemHealth EPO/PPO (GHI)

Requests may be submitted via the secure provider website: www.emblemhealth.com/providers, faxed to (212) 563-8391, or by calling the Coordinated Care Intake department at (800) 223-9870.

See Additional Prior Approval Procedures for GHI Practitioners for more information.

Medicare PPO (GHI)

Requests may be submitted via the secure provider website: www.emblemhealth.com/Providers or faxed to (877) 508-2643.

Call (866) 557-7300 for more information or to use the IVR system.

For questions regarding the prior approval process or the status of a specific request, call Customer Service at (877) 244-4466.

See Additional Prior Approval Procedures for GHI Practitioners for more information.

HealthCare Partners

Call (800) 877-7587 or fax your request to (888) 746-6433.

Montefiore CMO

Call (888) 666-8326.

For behavioral health services, call (800) 401-4822.

Empire BCBS

Effective January 1, 2016, utilization management for GHI PPO City of New York employees and non-Medicare eligible retirees with GHI PPO benefits will be managed by Empire BCBS for inpatient and outpatient services.

Call (800) 521-9574

Fax (800) 241-5308

For Infertility services, including artificial insemination and IVF:

Call WIN Fertility (833) 439-1515

To see what needs authorization, use their look-up tool: https://www.empireblue.com/wps/portal/ehpprovider.

Behavioral Health Services

Emblem Behavioral Health Services Program

Requests may be submitted via the Beacon Health Options website: https://www.beaconhealthoptions.com/providers/ or by calling Beacon Health Options at (888) 447-2526. (For members in plans underwritten by HIP or HIPIC)

EmblemHealth Behavioral Management Program

Requests may be submitted via the Beacon Health Options website: https://www.beaconhealthoptions.com/providers/ or by calling Beacon Health Options at (800) 692-2489. (For members in plans underwritten by GHI)

Montefiore

Requests may be submitted by calling (800) 401-4822. (For members who have the Montefiore logo on the lower left corner of their ID card)

Cardiology and Radiology Services; ; Durable Medical Equipment (DME)Skilled Nursing Facility; Inpatient Rehabilitation Facility; Long-Term Care FacilityHome Health Care

eviCore

Requests may be submitted via the eviCore website: www.evicore.com (submit post-acute care requests via Allscripts), or by calling (866) 417-2345 (for HIP members) or (800) 835-7064 (for EmblemHealth EPO/PPO members)
Chiropractic Services

HIP

Requests may be submitted via the Palladian website: www.palladianhealth.com, by calling (877) 774-7693 or faxed to (716) 809-8324.

Outpatient Physical and Occupational Therapy

HIP

Requests may be submitted via the Palladian website: www.palladianhealth.com, by calling (877) 774-7693, or faxed to (716) 809-8324.

Spine Surgery and Pain Management Therapy Program
HIP For forms via orthonet-online.com by calling (844) 730-8503. Requests and supporting clinical information must be faxed to (844) 296-4440.
Pharmacy Services
EmblemHealth Pharmacy Benefit Services

Call (877) 444-3657, Monday through Friday, 8 a.m. to 6 p.m.

EmblemHealth Injectable Drug Utilization Management Program

Requests may be submitted by calling (888) 447-0295, Monday through Friday, 8 a.m. to 6 p.m., or faxed to (877) 243-4812.

Specialty Pharmacy Program

Requests may be submitted via accredo.com by calling (855) 216-2166, Monday through Friday, 8:30 a.m. to 5 p.m. or faxed to (888) 302-1028.

Home Infusion Therapy

Requests may be submitted via Homeinfusion@emblemhealth.com by calling (800) 367-8103 (Voice Mail) or faxed to (212) 510-5978.

Pre-Certifications may be submitted via emblemhealth.com by calling (800) 223-9870 or faxed to (212) 563-8391.

 

Retail Pharmacy Services (Pharmacies)
EmblemHealth Pharmacy Services:
(877) 793-6253
, 24 hours a day, 7 days a week

 

Clinical Pharmacy Services (Providers)

EmblemHealth:
(877) 362-5670
, Monday through Friday, 8 a.m. to 6 p.m.

Express Scripts, Inc. (ESI):
(home delivery for all plan members except for state and federal employees and retirees with GHI coverage)
Physicians may call in new prescriptions to Express Scripts at (888) 327-9791.

Specialty Pharmacy Program:
(888) 447-0295
, Monday through Friday, 8:30 a.m. to 5 p.m.
Accredo:
855-216-2166
, Monday to Friday, 8 a.m. to 11 p.m.; Saturdays, 8 a.m. to 5 p.m.

 

Pharmacy Benefit Services (Members)

EmblemHealth: 
(for all members with the exception of GHI retirees and city, state and federal employees with GHI coverage) 
(877) 793-6253, Monday through Friday, 8 a.m. to 8 p.m.
TTY/TDD: 711

Medicare Pharmacy Line:
(for providers and Medicare members excluding retirees and city, state and federal employees with GHI coverage)
(877) 444-7097, Monday through Sunday, 8 a.m. to 8 p.m.
TTY/TDD: 711

Medicaid Pharmacy Line: 
(for providers and Medicaid members)
(888) 447-7364, Monday through Friday, 8 a.m. to 8 p.m.
TTY/TDD: 711
GHI Customer Service:
(for GHI retirees and city, state and federal employees with GHI coverage)
(800) 624-2414, Monday through Friday, 8 a.m. to 8 p.m.
If calling from New York City, members may also call (212) 615-4444.
TTY/TDD: 711

Express Scripts, Inc. (ESI):
(home delivery for all plan members except for state and federal employees and retirees with GHI coverage)

  • (877) 866-5798 (Commercial members excluding all City of New York Commercial members)
  • (877) 866-5828 (EmblemHealth Medicare members excluding all City of New York Medicare members)
  • (877) 866-4165 (EmblemHealth Medicaid members)
  • (866) 211-8379 (New York State of Health)
  • (877) 534-3682 (City of New York Commercial members)
  • (800) 585-5786 (City of New York Medicare members)
  • 711 (for users of TDD/TTY)

24 hours a day, 7 days a week

Physicians may call (888) 327-9791 for instructions on how to fax a prescription to ESI. In addition, members can speak to a registered pharmacist for medication counseling.



The table below includes a list of anesthesia groups whose doctors are available to come to your office so you can keep member care in-network.

Mobile In-Office Anesthesia/Sedation

Physician Group

Service Area

Commercial Plans (HIP/GHI)

Medicaid Plans (HIP)

Medicare Plans (HIP/GHI)

Contact Information

CADS Anesthesia Services PLLC Kings & Richmond Counties
Yes
Yes
Yes
Sue Beck:
(201) 804-5253
Long Island Anesthesia Physicians
Nassau & Suffolk Counties
Yes Yes Yes John Von Lintig:
(631) 744-3671, Ext. 103
NAPA 
(North American Partners in Anesthesia)
Kings, Nassau, Queens, Ulster & Suffolk Counties
Yes Yes Yes Deborah DiMatteo:
(516) 945-3036
SOMNIA Inc.
Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan & Ulster Counties
Yes Yes Yes Jeannette Brown:
(914) 637-3532

 

A Health Home is a care management service model whereby all of an individual's caregivers communicate with one another so that all of a patient's needs are addressed in a comprehensive manner. This is done primarily through a "care manager" who oversees and provides access to all of the services an individual needs to assure that they receive everything necessary to stay healthy, out of the emergency room and out of the hospital. Health records are shared among providers so that services are not duplicated or neglected. Health Home services are provided through a network of organizations – providers, health plans and community-based organizations. When all the services are considered collectively they become a virtual "Health Home."

It is very important for our physical health network practitioners to be aware of their patients’ mental health and substance use disorders. We ask our PCPs to screen their patients for depression and other potential issues and to take these diagnoses into consideration when developing treatment plans. Where possible, please identify and coordinate care with your patient’s behavioral health providers.

The following Enhanced Care Prime Network Health Homes support our Medicaid Managed Care, and HARP benefit plans.

 

EmblemHealth Medicaid Health Homes

Health Home/ DBA Partnerships

Counties

Contact

Bronx Accountable Healthcare Network(BAHN)

Bronx,Westchester

Antonette Mentor
(914) 378-6086
amentor@montefiore.org

Christine Whang
(914) 378-6151
chwwhan@montefiore.org

Mary Fernandez 
(914) 378-6554
maryfern@montefiore.org

Brooklyn Health Home(Maimonides)
(under Southwest Brooklyn Health Home)

Brooklyn

Sara Kaplan Levenson
(718) 283-7858
slevenson@maimonidesmed.org

Danielle Cuyuch
(718) 283-6194
dcuyuch@maimonidesmed.org

Community Care Management Partners LLC
(under Visiting Nurse Service of New York Home Care)

Counties serving Adults:
Bronx, Manhattan
Counties serving Children:
Bronx, Kings, Manhattan, Queens

Hillel Hirshbein
(212) 609-1536
Hillel.hirshbein@ccmphealthome.org

Nathan Smith
((212) 609-1543
Nathan.smith@ccmphealthhome.org

Community Health Care Network

Bronx, Brooklyn, Manhattan, Queens, Staten Island

Alyssa Lord
(212) 545-2469
alord@chnnyc.org

Carmen Plaja-Cordero
(212) 545-6226
cpcordero@chnnyc,org

Coordinated Behavioral Care Inc. 
(DBA Pathway to Wellness)

Counties serving Adults:
Brooklyn, Manhattan, Staten Island
Counties serving Children:
Bronx, Brooklyn, Manhattan, Queens, Staten Island

Amanda Semidey
(646) 930-8835
asemidey@cbcare.org

Melissa Martinez
(646) 930-8831
Mmartinez@cbccare.org

Hudson River Healthcare Inc. 
(DBA Community Health Care Collaborative)

Counties serving Adults:
Nassau, Suffolk, Westchester
Counties serving Children:
Nassau, Suffolk, Westchester

Kathleen Clay 
(914) 734-8513 
kclay@hrhcare.org

Christina Turiano 
(914) 829-5162
cturiano@cbccare.org

Hudson Valley Care Coalition
(under Open Door Family Medical Centers)

Westchester

Stephanie Griffith
(914) 488-6595
sgriffith@hvcare.net

Sean Allen
(914) 488-6610
seallen@hvcare.net

Mt. Sinai Health Home
(under St. Luke's-Roosevelt Hospital Center)

County serving Adults:
Manhattan 
Counties serving Children: 
Bronx, King, Manhattan, Queens, Staten Island

Lynette Verges
(212) 731-7931
Lynnette.verges@mountsinai.org

Alicia Korpi
(212) 731-7841 
Alicia.korpi@mountsinai.org

New York City Health and Hospital Corporation

Bronx, Brooklyn, Manhattan, Queens

Katherine Redfern-Shaw
(646) 458-5617
redfernk@nychhc.org

Cathleen Gittens
(646) 458-6423
Cathleen.gittens@nychhc.org

North Shore (formerly Northshore LIJ)

Nassau, Suffolk, Queens, Staten Island

Hira Ruskin
(516) 600-1132
hruskin@northwell.edu

Pat McCarrick
(516) 600-1129
pmccarrick@northwell.edu

Queens Coordinated Care Partners

Bronx, Brooklyn, Queens, Manhattan

Brian Timmermans
(718) 906-6246
Brian.timmermans@mountsinai.org

Oscar Laluyan
(718) 906-6243
Oscar.laluyan@mountsinai.org

NY Presbyterian

Manhattan

Tiffany Sturdivant-Morrison
(212) 342-0542
Tis9034@nyp.org

Henley Vargas
(212) 342-0590
Hev9012@nyp.org

Collaborative for Children and Families

Bronx, Brooklyn, Manhattan, Queens, Staten Island, Nassau, Suffolk, Westchester

Jodi Saitowitz
(646) 459-3971
jsaitowitz@ccfhh.org

Alyssa Tosi
(646) 459-3975
atossi@ccfhh.org

For more information on Health Homes and other Medicaid covered services, please see the Medicaid section of the Provider Networks and Member Benefit Plans chapter. 
For more information on EmblemHealth’s Behavioral Health Services Program, please see the Behavioral Health Services chapter.

Quest Diagnostics, Inc. is our preferred, independent free standing laboratory and provides most outpatient clinical services to our members. We also contract with other free-standing independent laboratories for certain specialty tests. In addition, physicians may also use network hospitals that have their own lab and pathology group(s) that are contracted with EmblemHealth. Depending on the member benefit plan, the member may have higher cost sharing when accessing these services through a network hospital. For more information on allowable in-office lab tests, please see the Laboratory Services section of the Care Management chapter.

Contracted laboratories will provide a collection box and courier service to and from the practitioner's office for specimen collection. If specimens need to be drawn outside of the practitioner's office, members should be directed to the nearest contracted laboratory Patient Service Center and given the requisition form to hand carry. The nearest Quest Diagnostics Patient Service Center may be found by calling 1-800-377-8448.

EmblemHealth has contracts with laboratories to provide lab services for our EmblemHealth, GHI and HIP plan members. Please use these network laboratories when requesting lab services for our members. All services for out-of-network providers require prior authorization. If you do not have an account with any of our network laboratories, please establish one as needed by calling the applicable phone number(s) below.

EmblemHealth Network Laboratory Services

Laboratory

Plans Covered

Phone Number

Website

Routine Clinical Laboratory Services

Quest Diagnostics, Inc. All Networks and Plans (866) 697-8378 www.questdiagnostics.com

ACM Medical Laboratory

GHI-Underwritten
Networks and Plans ONLY

(800) 525-5227

www.acmlab.com

Lab Alliance of
Central New York, LLC
GHI-Underwritten
Networks and Plans ONLY
(315) 461-3008 www.laboratoryalliance.com
Shiel Medical Laboratory, Inc. - Not Participating as of May 1, 2018 GHI-Underwritten
Networks and Plans ONLY
(718) 552-1000 www.shiel.com

Cardiovascular Disease

Quest Diagnostics, Inc. All Networks and Plans (866) 697-8378 www.questdiagnostics.com

Dermatopathology

Quest Diagnostics, Inc. All Networks and Plans (866) 697-8378 www.questdiagnostics.com
AmeriPath New York, LLC
(aka Dermpath Diagnostics & Ackerman Academy of Dermatopathology)
All Networks and Plans Dermpath:
(800) 942-3376
Ackerman:
(800) 553-6621
www.ameripath.com
InterScience Diagnostics GHI-Underwritten
Commercial
Networks and Plans ONLY
(718) 698-5461 www.interwsciencelabs.net
Lakewood Pathology Associates
(dba PLUS Diagnostics)
GHI-Underwritten
Networks and Plans ONLY
(800) 440-7284  www.plusdx.net

Dialysis Testing

DaVita Labs All Networks and Plans (800) 604-5227 www.davita.com
Spectra Laboratories All Networks and Plans (800) 522-4662 
(800) 433-3773
www.spectra-labs.com

Endocrinology

Quest Diagnostics, Inc. All Networks and Plans (866) 697-8378 www.questdiagnostics.com

Gastroenterology

Quest Diagnostics, Inc. All Networks and Plans (866) 697-8378 www.questdiagnostics.com
AmeriPath New York All Networks and Plans (866) 393-7434 www.ameripath.com
Lakewood Pathology Associates
(dba PLUS Diagnostics)
GHI-Underwritten
Networks and Plans ONLY
(800) 440-7284 www.plusdx.net

Gene-Based Testing

Quest Diagnostics, Inc. All Networks and Plans (866) 697-8378 www.questdiagnostics.com
AmeriPath New York, LLC
(aka AmeriPath Northeast)
All Networks and Plans (866) 436-9631 www.ameripath.com
Genomic Health All Networks and Plans (866) 662-6897 www.genomichealth.com
Mount Sinai Genetic
Testing Laboratory
All Networks and Plans (212) 241-7518 www.mssm.edu

Hematology/Oncology

Quest Diagnostics, Inc. All Networks and Plans (866) 697-8378 www.questdiagnostics.com
AmeriPath New York, LLC
(aka AmeriPath Northeast)
All Networks and Plans (800) 440-7284 www.ameripath.com
Lakewood Pathology Associates
(dba PLUS Diagnostics)
GHI-Underwritten
Networks and Plans ONLY
(800) 440-7284 www.plusdx.net

Neurology

Quest Diagnostics, Inc. All Networks and Plans (866) 697-8378 www.questdiagnostics.com

Pain Management

Quest Diagnostics, Inc. All Networks and Plans (866) 697-8378 www.questdiagnostics.com
American Forensic
Toxicology Services
All Networks and Plans (855) 895-8090 www.aftslabs.com

Urology

Quest Diagnostics, Inc. All Networks and Plans (866) 697-8378 www.questdiagnostics.com
AmeriPath New York All Networks and Plans (866) 393-7434 www.ameripath.com
Lakewood Pathology Associates
(dba PLUS Diagnostics)
GHI-Underwritten
Networks and Plans ONLY
(800) 440-7284 www.plusdx.net

Note: A full list of Provider Networks and Member Benefit Plans may be found in the Provider Networks and Member Benefit Plans Chapter. Providers are encouraged to subscribe to receive updates by clicking the subscribe icon above.

STAT Laboratory Services

Selected tests are available on a STAT (emergency) basis. Specimens requiring STAT services should not be given to your routine Route Service Representative. Instead, practitioners should call the Quest Diagnostics Logistics department for STAT specimen pick-up at the number listed below. Practitioners may also consult their local Quest Diagnostics laboratory for more information.

STAT results are reported by telephone as soon as available. Written and/or electronic reports will follow per your routine medical report delivery system.

Please contact your local Quest Diagnostics laboratory to request a STAT service or pick-up: 
New York (excluding Long Island): Logistics department: 1-800-223-0570 
Long Island (Nassau and Suffolk Counties): Logistics department: 1-800-877-7588 
New Jersey: STAT laboratory direct number: 1-800-648-4738

The Health Clinics/Community Health Centers’ mission is to serve as a focal point for increasing access to both primary and multi-specialty care services to improve the health status of the residents in the communities they serve. Community Health Centers (CHC) include health centers such as Diagnostic & Treatment Centers (DT&C), Federally Qualified Health Centers (FQHC) and other clinics. They are conveniently located within the communities they serve, offer onsite multi-specialty services, and are staffed by personnel that understand the cultural/linguistic and spiritual needs and beliefs of the neighborhoods they serve.

All providers must verify member eligibility and benefits prior to rendering non-emergency services.

Health Centers

Health Centers (Downstate)

Address

Phone Number
(Members)

Phone Number
(Providers)

Access Community Health Center 83 Maiden Lane, 6th Fl. 
New York, NY 10038
(212) 895-3410 (212) 895-3410
APICHA Community Health Center 400 Broadway
New York, NY 10013
(212) 334-6029 (212) 334-7940
Be Well Family Health Care 2019 Nostrand Ave
Brooklyn, NY 11210
(718) 434-0711 (718) 434-0711
Beacon Christian Community Health Center, Inc. 2079 Forest Ave
Staten Island, NY 10303
(718) 815-6560 (718) 815-6560
Bedford Medical Family Health 100 Ross St
Brooklyn, NY 11211
(718) 387-7628 (718) 387-7628
Bedford Medical Family Health 341 Wallabout St
Brooklyn, NY 11206
(718) 218-6089 (718) 218-6089
Bedford-Stuyvesant Family Health Center 1413 Fulton St
Brooklyn, NY 11216
(718) 636-4500 (718) 636-4500
Betances Family Health Care 280 Henry St
New York, NY 10002
(212) 227-8401 (212) 227-8401
Boriken Neighborhood Health Center 2253 3rd Ave
New York, NY 10035
(212) 289-6650 (212) 289-6650
Brooklyn Plaza Medical Center, Inc. (BPMC) - Whitman Ingersoll Farragut Health Center of BPMC 297 Myrtle Ave
Brooklyn, NY 11205
(718) 596-8000 (718) 596-8000
Brooklyn Plaza Medical Center, Inc. (BPMC) 650 Fulton St
Brooklyn, NY 11217
(718) 596-9800 (718) 596-9800
Brownsville Multi-Service Family Health Center - Bms Institute for Specialty & Integrative Services (isis) 259 Bristol St
Brooklyn, NY 11212
(718) 342-0060 (718) 342-0060
Brownsville Multi-Service Family Health Center - Main 592 Rockaway Ave
Brooklyn, NY 11212
(718) 345-5000 (718) 345-5000
Brownsville Multi-Service Family Health Center - Bms @ Genesis 360 Snediker Ave
Brooklyn, NY 11207
(646) 459-9400 (646) 459-9400
Brownsville Multi-Service Family Health Center - Bms - SBHC 400 Pennsylvania Ave
Brooklyn, NY 11207
(718) 345-5000 (718) 345-5000
Callen-Lorde Community Health Center 356 West 18th St
New York, NY 10011
(212) 271-7200 (212) 271-7200
Care for the Homeless 30 East 33rd St, 5th Floor
New York, NY 10016
(212) 366-4459 (212) 366-4459
Century Medical & Dental Center 260 Ave X
Brooklyn, NY 11223
(718) 336-8855 (718) 336-8855
Charles B. Wang Community Health Center 125 Walker St
New York, NY 10013
(212) 226-3888 (212) 226-3888
Charles B. Wang Community Health Center 268 Canal St
New York, NY 10013
(212) 379-6999 (212) 379-6999
Charles B. Wang Community Health Center 132-26 37th Ave
Flushing, NY 11354
(718) 886-1212 (718) 886-1212
Citicare, Inc. 154 W 127th St
New York, NY 10027
(212) 749-3508 (212) 749-3507
Community Health Center of Richmond 235 Port Richmond Ave
Staten Island, NY 10302
(718) 876-1732 (718) 876-1732
Community Healthcare Network - Dr. Betty Shabazz Health Center 999 Blake Ave
Brooklyn, NY 11208
(718) 277-8303 (718) 277-8303
Community Healthcare Network - Bronx, Health Center 975 Westchester Ave
Bronx, NY 10459
(718) 320-4466 (718) 320-4466
Community Healthcare Network - CABS Health Center 94-98 Manhattan Ave
Brooklyn, NY 11206
(718) 388-0390 (718) 388-0390
Community Healthcare Network - Caribbean House Health Center 1167 Nostrand Ave
Brooklyn, NY 11225
(718) 778-0198 (718) 778-0198
Community Healthcare Network - Community League Health Center 1996 Amsterdam Ave
New York, NY 10032
(212) 781-7979 (212) 781-7979
Community Healthcare Network - Catherine M. Abate Health Center 150 Essex St
New York, NY 10002
(212) 477-1120 (212) 477-1120
Community Healthcare Network - Family Health Center 90-04 161st St
Jamaica, NY 11432
(718) 523-2123 (718) 523-2123
Community Healthcare Network - Helen B. Atkinson Health Center 81 W 115th St
New York, NY 10026
(212) 426-0088 (212) 426-0088
Community Healthcare Network - Queens Health Center 97-04 Sutphin Blvd
Queens, NY 11435
(718) 657-7088 (718) 657-7088
Community Healthcare Network - Tremont Health Center 4215 Third Ave
Bronx, NY 10457
(718) 294-5891 (718) 294-5891
Community Healthcare Network - Long Island City Health Center 36-11 21st St
Queens, NY 11106
(718) 482-7772 (718) 482-7772
Community Healthcare Network - Manhattan Health Center 60 Madison Ave, 5th Fl.
New York, NY 10010
(212) 545-2400 (212) 545-2400
Covenant House 460 W 41st St
New York, NY 1003
(212) 613-0300 (212) 613-0300
Damian Family Health Center 137-50 Jamaica Ave
Jamaica , NY 11435
(718) 298-5100 (718) 298-5100
Ezra Medical Center 1312 38th St
Brooklyn, NY 11218
(718) 686-7600 (718) 686-7600
First Medcare Inc. 8707 Flatlands Ave,
Brooklyn, NY 11236
(718) 257-7777 (718) 257-7777
Brightpoint Health (f/k/a Help/Psi) 373 Park Ave
New York, NY 10016
(718) 681-8700 (718) 681-8700
Heritage Health Care Center 1727 Amsterdam Ave
New York, NY 10031
(212) 862-0054 (212) 862-0054
Health and Hospitals Corporation (HHC) - Cumberland Diagnostic and Treatment Center
100 North Portland Ave
Brooklyn, NY 11206
(718) 260-7500 (718) 260-7500
Health and Hospitals Corporation (HHC) - Cumberland Diagnostic and Treatment Center 
Eleanor Roosevelt Houses Child Health Clinic
388 Pulaski St
Brooklyn, NY 11221
(718) 388-5889 (718) 452-1146
Health and Hospitals Corporation (HHC) - Cumberland Diagnostic and Treatment Center
Fort Greene Child Health Clinic
295 Flatbush Ave
Brooklyn, NY 11201
(718) 388-5889 (718) 643-4487
Health and Hospitals Corporation (HHC) - Cumberland Diagnostic and Treatment Center 
Jonathan Williams Houses Child Health Clinic
333 Roebling St
Brooklyn, NY 11211
(718) 388-5889 (718) 387-6407
Health and Hospitals Corporation (HHC) - Cumberland Diagnostic and Treatment Center 
Lafayette Houses Child Health Clinic
434 Dekalb Ave
Brooklyn , NY 11205
(718) 388-5889 (718) 638-8258
Health and Hospitals Corporation (HHC) - Cumberland Diagnostic and Treatment Center
Sumner Avenue Houses Child Health Clinic
47 Marcus Garvey Blvd
Brooklyn, NY 11206
(718) 388-5889 (718) 455-4700
Health and Hospitals Corporation (HHC) - East New York Diagnostic and Treatment Center
2094 Pitkin Ave
Brooklyn, NY 11207
(718) 240-0400 (718) 240-0400
Health and Hospitals Corporation (HHC) - East New York Diagnostic and Treatment Center
Sutter Avenue CHC
1091 Sutter Ave
Brooklyn, NY 11212
(718) 647-0800 (718) 647-0800
Health and Hospitals Corporation (HHC) -East New York Diagnostic and Treatment Center
Brownsville CHC
259 Bristol St
Brooklyn, NY 11212
(718) 495-7283 (718) 495-7283
Health and Hospitals Corporation (HHC) -East New York Diagnostic and Treatment Center
Crown Heights Child Health Clinic
1218 Prospect Place
Brooklyn, NY 11212
(718) 953-8233 (718) 953-8233
Health and Hospitals Corporation (HHC) -Gouverneur Healthcare Services 227 Madison St
New York, NY 10002
(212) 238-7897 (212) 238-7897
Health and Hospitals Corporation (HHC) - East New York Diagnostic and Treatment Center
Smith Family Health Clinic
60 Madison St
New York, NY 10038
(212) 346-0511 (212) 346-0511
Health and Hospitals Corporation (HHC) - East New York Diagnostic and Treatment Center
Judson Health Center
34 Spring St
New York, NY 10012
(212) 925-5000 (212) 925-5000
Health and Hospitals Corporation (HHC) -East New York Diagnostic and Treatment Center
Roberto Clemente Health Center/Sylvia Del Villard
540 13th St
New York, NY 10019
(212) 387-7400 (212) 387-7400
Health and Hospitals Corporation (HHC) - Morrisania Diagnostic and Treatment Center 1225 Gerard Ave
Bronx, NY 10452
(718) 960-2777 (718) 960-2777
Health and Hospitals Corporation (HHC) -Morrisania Diagnostic and Treatment Center
Daniel Webster Child Health Center
401 E 168th St
Bronx, , NY 10456
(718) 538-1982 (718) 538-1982
Health and Hospitals Corporation (HHC) - Renaissance Healthcare Network Diagnostic & Treatment Center (Sydenham Health Center) 264 W 118th St
New York, NY 10026
(212) 932-6500 (212) 932-6500
Health and Hospitals Corporation (HHC) -Renaissance Healthcare Network Diagnostic & Treatment Center (Sydenham Health Center) 
Drew Hamilton Health Center
2698 Frederick Douglas Blvd
New York, NY 10039
(212) 939-8950 (212) 939-8950
Health and Hospitals Corporation (HHC) - Renaissance Healthcare Network Diagnostic & Treatment Center (Sydenham Health Center)
Grant Houses Health Center
3170 Broadway
New York, NY 10027
(212) 678-2420 (212) 678-2420
Health and Hospitals Corporation (HHC) - Renaissance Healthcare Network Diagnostic & Treatment Center (Sydenham Health Center) 
Washington Heights Child Health Center
600 W 168th St
New York, NY 10032
(212) 491-1661 (212) 491-1661
Health and Hospitals Corporation (HHC) - Renaissance Healthcare Network Diagnostic & Treatment Center (Sydenham Health Center) 
Dyckman Clinica De Las Americas
175 Nagle Ave
New York, NY 10034
(212) 544-2001 (212) 544-2001
Health and Hospitals Corporation (HHC) -Renaissance Healthcare Network Diagnostic & Treatment Center (Sydenham Health Center) 
St. Nicholas Houses Child Health Center
281 W 127th St
New York, NY 10027
(212) 865-1300 (212) 865-1300
Health and Hospitals Corporation (HHC) - Segundo Ruiz Belvis Diagnostic and Treatment Center 545 E 142nd St
Bronx, NY 10454
(718) 960-2777 (718) 960-2777
Health and Hospitals Corporation (HHC) - Segundo Ruiz Belvis Diagnostic and Treatment Center
Melrose Houses Child Health Center
348 E 156th St
Bronx, NY 10451
(718) 292-2820 (718) 292-2820
Hill Top Family Health Center 251-12 Hillside Ave
Bellerose, NY 11426
(718) 831-1700 (718) 831-1700
Hillside Polymedic Diagnostic and Treatment Center 187-30 Hillside Ave
Jamaica, NY 11432
(718) 264-1111 (718) 264-1111
Joseph P. Addabbo Family Health Center, Inc. - Central Avenue, Far Rockaway 1288 Central Ave
Far Rockaway, NY 11691
(718) 945-7150 (718) 945-7150
Joseph P. Addabbo Family Health Center, Inc. - Arverne, Queens 6200 Beach Channel Dr
Far Rockaway, NY 11692
(718) 945-7150 (718) 945-7150
Joseph P. Addabbo Family Health Center, Inc. - Guy Brewer Boulevard, Jamaica 11811 Guy R Brewer Blvd
Jamaica, NY 11434
(718) 945-7150 (718) 945-7150
Joseph P. Addabbo Family Health Center, Inc. 120 Richards St
Brooklyn, NY 11231
(718) 945-7150 (718) 945-7150
Acacia Network Community Health Centers - La Casa De Salud Health Center 966 Prospect Ave
Bronx, NY 10460
(718) 842-1412 (718) 842-1412
Long Island FQHC - Westbury Family Health Center 682 Union Ave
New York, NY 11590
(516) 571-9500 (516) 571-9500
Long Island FQHC Hempstead Family Health Center 135 Main St
Hempstead, NY 11550
(516) 572-1300 (516) 572-1300
Long Island FQHC - Elmont Family Health Center 161 Hempstead Tpke
Elmont, NY 11003
(516) 571-8200 (516) 571-8200
Long Island FQHC - Roosevelt Family Health Center 380 Nassau Rd
Roosevelt, NY 11575
(516) 571-8600 (516) 571-8600
NYU Lutheran Family Health Centers - Brooklyn-Chinese 5008 7th Ave
Brooklyn, NY 11221
(718) 210-1030 (718) 210-1030
NYU Lutheran Family Health Centers - Caribbean-American 3414 Church Ave
Brooklyn, NY 11203
(718) 630-2197 (718) 630-2197
NYU Lutheran Family Health Centers - Park Ridge 6317 4th Ave
Brooklyn, NY 11220
(718) 907-8100 (718) 907-8100
NYU Lutheran Family Health Centers - Park Slope 220 13th St
Brooklyn, NY 11215
(718) 832-5980 (718) 832-5980
NYU Lutheran Family Health Centers - Shore Road 9000 Shore Rd
Brooklyn, NY 11209
(718) 630-8870 (718) 630-8870
NYU Lutheran Family Health Centers - Sunset Park 5610 2nd Ave
Brooklyn, NY 11220
(718) 630-7942 (718) 630-7942
NYU Lutheran Family Health Centers - Sunset Park (55th St) 150 55th St
Brooklyn, NY 11220
(718) 630-7095 (718) 630-7095
NYU Lutheran Family Health Centers - Family Physician 5616 6th Ave
Brooklyn, NY 11220
(718) 439-5440 (718) 439-5440
NYU Lutheran Family Health Centers - Sunset Terrace 514 49th St
Brooklyn, NY 11220
(718) 431-2600 (718) 431-2600
Medcare LLC Health Center 468 Lafayette Ave
Brooklyn, NY 11205
(718) 399-6234 (718) 399-6234
Morris Heights Health Center - Main Site 85 W Burnside Ave
Bronx, NY 10453
(718) 716-4400 (718) 483-1270
Morris Heights Health Center - MHHC at 137th Street 625 E 137th St
Bronx, NY 10454
(718) 716-4400 (718) 401-6578
Morris Heights Health Center - MHHC at 233rd Street 825 East 233 St
Bronx, NY 10466
(718) 716-4400 (718) 716-4400
Morris Heights Health Center - MHHC at Harrison Circle 57-69 W Burnside Ave
Bronx, NY 10453
(718) 716-4400 (718) 483-1270
Morris Heights Health Center - MHHC at Melrose 77 Melrose Ave
Bronx, NY 10451
(718) 716-4400 (718) 716-4400
Morris Heights Health Center - MHHC at Walton Avenue 25 E 183rd St
Bronx, NY 10453
(718) 716-4400 (718) 839-8900
Morris Heights Health Center - Women’s Health Pavilion 70 W Burnside Ave
Bronx, NY 10453
(718) 716-4400 (718) 716-2229
Mount Sinai Multispecialty Physicians 150 E 77th St
New York, NY 10021
(212) 439-6000 (212) 439-6000
ODA 420 Broadway
Brooklyn, NY 11211
(718) 384-3475 (718) 384-3475
Pelham Physical Medicine Inc. 2118 Williamsbridge Rd
Bronx, NY 10461
(718) 823-3900 (718) 823-3900
Phoenix House 164 W 74th St
New York, NY 10023
(800) 378-4435 (800) 378-4435
Project Renewal 200 Varick St
New York, NY 10014
(212) 620-0340 (212) 620-0340
Queens Medical Pavilion 69-15 Austin St
Forest Hills, NY 11375
(718) 263-3500 (718) 263-3500
St. John's Episcopal Hospital - Episcopal Health Services Inc. 327 Beach 19th St
Queens, NY 11691
(718) 869-7000 (718) 869-7000
St. John's Episcopal Medical Services - Ambulatory Care Center At JASA 131 Beach 19th St
Far Rockaway, NY 11691
(718) 869-8282 (718) 869-8282
The Floating Hospital - Long Island City 4140 27th St
Long Island City, NY 11101
(718) 784-2240 (718) 784-2240
Union Community Health Center Inc. (UCHC) 260 East 188th St
Bronx, , NY 10458
(718) 220-2020 (718) 220-2020
Union Community Health Center Inc. (UCHC) 2021 Grand Concourse
Bronx, NY 10453
(718) 220-2020 (718) 220-2020
Union Community Health Center Inc. (UCHC) 470 East Fordham Rd
Bronx, NY 10458
(718) 220-2020 (718) 220-2020
Union Community Health Center Inc. (UCHC) 4487 Third Ave
Bronx, NY 10457
(718) 220-2020 (718) 220-2020
Union Health Center 275 7th Ave
New York, NY 10001
(212) 924-2510 (212) 924-2510
The William F. Ryan Community Health Network - William F. Ryan Community Health Center (Upper West Side) 110 W 97th St
New York, NY 10025
(212) 749-1820 (212) 749-1820
The William F. Ryan Community Health Network - Ryan/Chelsea-Clinton Community Health Center (Midtown West) 645 Tenth Ave
New York, NY 10036
(212) 265-4500 (212) 265-4500
The William F. Ryan Community Health Network - Ryan-NENA Community Health Center (Lower East Side) 279 E 3rd St
New York, NY 10009
(212) 447-8500 (212) 447-8500
The William F. Ryan Community Health Network - Ryan/Adair Community Health Center 565 Manhattan Ave
New York, NY 10027
(212) 222-5221 (212) 222-5221
The William F. Ryan Community Health Network - The Ryan Women and Children's Center 801 Amsterdam Ave
New York, NY 10025
(212) 316-8300 (212) 316-8300
The Institute for Family Health - Family Health Center of Harlem 1824 Madison Avenue
New York, NY 10035
(212) 423-4500 (212) 423-4500
The Institute for Family Health - Sidney Hillman/Phillips Family Practice 16 East 16th St
New York, NY 10003
(212) 206-5200 (212) 206-5200
The Institute for Family Health - Amsterdam Family Health Center 690 Amsterdam Avenue
New York, NY 10025
(212) 865-4104 (212) 865-4104
The Institute for Family Health - Walton Family Health Center and Center for Counseling 1894 Walton Avenue
Bronx, NY 10453
(718) 583-3060 (718) 583-3060
The Institute for Family Health - Mt. Hope Family Practice 130 West Tremont Avenue
Bronx, NY 10453
(718) 583-9000 (718) 583-9000
The Institute for Family Health - Stevenson Family Health Center 731 White Plains Road
Bronx, NY 10473
(718) 589-8775 (718) 589-8775
The Institute for Family Health - Urban Horizons Family Health Center 50 E 168th St 
Bronx, NY 10452
(718) 293-3900 (718) 293-3900
The Institute for Family Health - Kingston Family Health Center 1 Family Practice Drive
Kingston, NY 12401
(845) 338-6400 (845) 338-6400
The Institute for Family Health - New Paltz Family Health Center 279 Main St, Suite 102
New Paltz, NY 12561
(845) 255-2930 (845) 255-2930

For urgent conditions that do not meet the layperson's definition of an emergency, all EmblemHealth plan members have access to network urgent care centers.

To find a list of network urgent care centers, use the Find a Doctor tool on our website. You may also call Member Customer Service to obtain this information.

Vytra plan members should visit www.emblemhealth.com or call the EmblemHealth Customer Service line at 1-866-409-0999.

For more information on urgent care centers, please visit the Urgent Care Centers section of the Care Management chapter.

For process terminology, filing instructions and applicable time frames for disputing determinations that result in a denial of payment and/or covered services, please go to the following chapters:

Additional Resources (Providers and Members)

Entity Address Phone Email/Comments
Chiropractic and Physical/Occupational Therapy

Palladian Muscular Skeletal Health

2732 Transit Road
West Seneca, NY 14224

(877) 774-7693

www.palladianhealth.com

Delegated for utilization management.

Dental Services

DentaQuest

 

(844) 822-8108, Monday to Friday from 8 am to 5 pm.

www.dentaquest.com

Managing Entities

HealthCare Partners(HCP)

501 Franklin Ave., Suite 300
Garden City, NY 11530-5807

(516) 746-2200 or
(888) 746-2200

www.hcpipa.com

Delegated for credentialing, utilization management, claims processing (except for HCP Cohort 2) and first call resolution.

Montefiore CMO

100 Corporate Drive
Yonkers, NY 10701

(877) 447-6668

www.montefiore.org

Delegated for credentialing, utilization management and claims processing.

Radiology Services

eviCore

P.O. Box 61022
Anaheim, CA 92803

(800) 918-8924

www.evicore.com
Vision Services -Update for EyeMed
EyeMed Vision Care
For all members with a vision care benefit
4000 Luxottica Place
Mason, Ohio 45040
877-324-2791
Medicaid

877-324-4063
Commercial (HMO, PPO, POS)

877-324-6211
On/Off Individual and Group Exchange and Essential Plans
EyeMed conducts claims processing for routine vision claims. There are specific CPT and diagnosis codes that fall under the umbrella of claims paid by EyeMed.
Injectables and Specialty Pharmacy Program – Update of Magellen RX

ICORE National, LLC

5850 T.G. Lee Blvd., 
Suite 510 Orlando, FL 32822

(800) 424-4088

www.icorehealthcare.com Delegated for utilization management.

Language Line: Interpreter Service

Free multi-language interpreter service is available to assist providers and their patients. Services are available in over 200 languages, including English, Spanish, Chinese Mandarin, Chinese Cantonese, Tagalog, French, Vietnamese, German, Korean, Russian, Arabic, Italian, Portuguese, French Creole, Polish, Hindi and Japanese. To access an interpreter, providers may call 1-866-447-9717 and a Provider Customer Care Advocate will assist you.

Sign Language Interpreter Services of the Speech and Hearing Impaired

Providers, members or their designee can contact the Customer Service Department via phone at 1-646-447-6534 or Teletypewriter (TTY/TDD) at 1-800-874-9426 to request a sign language interpreter for a provider appointment.

If the member calls, he or she will be asked to have the provider contact EmblemHealth to arrange for the interpreter. If the member is communicating through EmblemHealth's TTY/TDD services by calling 711, the relay agent can contact the Interview Unit with the provider while the member is "holding" to verify the appointment. The Interview Unit will contact the member to confirm the interpreter arrangements. We primarily arrange these services through Deaf & Hard of Hearing Interpreting Services or Mill Neck Interpreter Services.

Lighthouse International

www.lighthouse.org

Lighthouse International is a leading worldwide resource on vision impairment and vision rehabilitation. Through its work in vision rehabilitation services, education, research and advocacy, Lighthouse International enables people of all ages who are blind or partially sighted to lead independent and productive lives.

 

New York City Headquarters
111 East 59th Street
New York, NY 10022-1202

 

Westchester County Regional Office
170 Hamilton Avenue
White Plains, NY 10601

Early Intervention Program (EIP)

New York State law requires that all primary referral sources (e.g., primary care physicians (PCPs), specialists, hospitals, etc.) shall, within two working days of identifying a child under 3 years of age with either a risk factor for developmental delay or an actual developmental delay or disability, refer that child to the Local Early Intervention Agency (LEIA) corresponding to the child's county of residence. In most cases, the LEIA is the County Department of Health. Parental consent is required for referral. The EIP has two components:

  • The Infant Child Health Assessment Program (ICHAP) serves as the "child find" component. Only children with a risk factor for developmental delay should be referred to this component. Referred children are tracked to insure that their pediatricians/PCPs conduct periodic developmental assessments and if such assessments indicate developmental delay, the program facilitates referrals to the EIP component.
  • The Early Intervention Program (EIP) provides for evaluation and developmental services when a child has or is suspected of having a developmental delay. Services are provided by the LEIA's network of approved EIP providers. The LEIA is under no obligation to use providers in the child's health plan network. When the services rendered are covered by a third party, the LEIA is authorized to bill the third party on behalf of the servicing provider.

For information please call the New York State Growing Up Healthy Hotline at 1-800-522-5006 (TTY/TDD: 1-800-655-1789). You may also call the LEIAs at:

  • New York City: 1-800-577-BABY (1-800-577-2229) or 1-212-219-5213
  • Nassau County: 1-516-227-8661
  • Suffolk County: 1-631-853-3100
  • Westchester County: 1-914-813-5094
  • Orange County: 1-845-291-2333
  • Rockland County: 1-845-364-2625

Preschool Supportive Health Services Program (PSHSP)

When children between 3 and 4 years of age are identified as having or are at risk of developmental disability, pediatricians/PCPs shall, with parental consent, refer the children to the Committee on Special Preschool Education serving the school district in which the children reside. This program ensures that such children are evaluated and receive needed special education and that disability-related health services are provided by PSHSP providers approved by the Committee on Preschool Special Education. The program is under no obligation to use providers in the child's health plan network. The school district bills the state for services rendered to Medicaid managed care members. When the services rendered to non-Medicaid members are covered by a third party, the school district is authorized to bill the third party on behalf of the servicing provider.

School Supportive Health Services Program (SSHSP)

When children between 5 and 21 years of age are identified as at risk for or having a developmental disability, pediatricians/PCPs shall, with parental consent, refer the children to the Committee on Special Education serving the school district in which the children reside. This program ensures that such children are evaluated and receive needed special education and that disability-related health services are provided by SSHSP providers approved by the Committee on Special Education. The program is under no obligation to use providers in the child's health plan network. The school district bills the state for services rendered to Medicaid managed care members. When the services rendered to non-Medicaid members are covered by a third party, the school district is authorized to bill the third party on behalf of the servicing provider.

Physically Handicapped Children's Program (PHCP)

PHCP provides financial assistance for medical care and support services to children that have severe, long-term health problems and chronic disabilities. Eligible conditions include birth defects, physical handicaps and other conditions that can be improved with treatment and early intervention.

PHCP has two components: the Diagnosis and Evaluation Program and the Treatment Program. Diagnostic services are available to all children who are believed to have physically disabling conditions or serious chronic illnesses. To receive diagnostic services, families do not have to satisfy local financial eligibility criteria, but prior authorization from the local PHCP must be obtained. Diagnostic services are provided through approved specialty centers or medical specialists. If the child is covered by health insurance or Medicaid, these funding sources must be billed first. If the child has neither insurance nor Medicaid, then the authorized services are paid for directly by the PHCP.

The treatment component reimburses health care providers for services rendered to eligible children. Inpatient hospital care, physician office visits, durable medical equipment and pharmaceuticals are examples of items covered by the program. PHCP will cover the cost of medically needed care and supplies not covered by some health insurance plans, such as over the counter drugs/supplies and transportation.

Application for the Treatment Program must be made to the county in which the child resides. There are some variations between counties for conditions covered and financial eligibility. Financial criteria are designed to assist families with low incomes or inadequate private health insurance. All services provided under PHCP must have prior authorization from the county health department.

For more information, please call the New York State Growing Up Healthy Hotline at 1-800-522-5006 or:

  • New York City: 1-212-676-2950
  • Nassau County: 1-516-571-0801
  • Suffolk County: 1-631-853-2286
  • Westchester County: 1-914-813-5328
  • Orange County: 1-845-568-5280
  • Rockland County: 1-845-364-2081

Project TEACH - Connecting Primary Care with Child Psychiatry

Primary care physicians (PCPs) such as pediatricians and family practice doctors are often the first place families go to seek help or information about emotional or behavioral concerns with their children. Project TEACH provides all pediatric primary care providers (PCPs) in New York State with access to rapid consultation, education and training, and referral/ linkage services to help them care for children and adolescents with mental health disorders. Additionally, other prescribers who are providing ongoing treatment to children, such as Child and Adolescent Psychiatrists, General Psychiatrists and Psychiatric Nurse Practitioners, may request a second opinion through consultation. For more information about the Project TEACH visit projectTEACHny.com.