Chapter 2: Directory

EmblemHealth
55 Water Street
New York, NY 10041-8190

Provider Services is available 8 a.m. to 6 p.m., Monday to Friday. Teletypewriter (TTY/TDD) services can be reached by calling 711.

For Claims Contacts please go here

For Preauthorization Contacts, please go here.

For Pharmacy Services Contacts, please go here.

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

For Health Homes Contacts, please go here.

Quest Diagnostics, Inc. is our preferred, free-standing independent laboratory that can provide most outpatient clinical services to our members. We also contract with other free-standing independent laboratories for certain specialty tests. In addition, physicians may use network hospitals with their own EmblemHealth-contracted lab and pathology group(s). Some member benefit plans have higher cost-sharing for lab services through a network hospital. Please use these network laboratories when requesting lab services for our members. All services for out-of-network providers require Preauthorization. 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). Refer to the list of Network Laboratory Services For All Plan Members.

For information on allowable in-office lab tests, please see Claims Corner.

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 888-277-8772 or online.

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 Logistics Department to request a STAT service or pick-up:

• New York (excluding Long Island): 800-223-0570
  
• Long Island (Nassau and Suffolk Counties): 800-877-7588
  
• New Jersey: STAT laboratory direct number: 800-648-4738

Community Health Centers (CHCs) provide high-quality, patient-centered, community-based primary and multi-specialty care to anyone who needs care, regardless of an individual’s ability to pay. CHCs include health centers such as Federally Qualified Health Centers, Rural Health Clinics, and Diagnostic and Treatment Centers. CHCs are conveniently located in communities, and are staffed by personnel who understand the cultural, linguistic, and spiritual needs and beliefs of the patients they serve. To find a list of community health centers, use the Find a Doctor tool at emblemhealth.com/find-a-doctor.

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 at emblemhealth.com/find-a-doctor.

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:

• Dispute Resolution - Commercial & Child Health Plus

• Dispute Resolution - Medicaid, HARP, & Essential Plan

• Dispute Resolution - Medicare

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 866-447-9717 and a Provider Customer Care Advocate will assist you.

Sign Language Interpreter Services for the Speech and Hearing Impaired

Providers, members, or their designee can contact the Customer Service Department 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 Service.

Lighthouse Guild

www.lighthouseguild.org

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

250 W. 64th Street
New York, NY 10023
800-284-4422 Monday - Friday 9 am to 5 pm

Early Intervention Program (EIP)

The Early Intervention Program (EIP) providesevaluation and developmental services when a child has or is suspected of having a developmental delay. The EIP has two components:

• The Infant-Child Health Assessment Program (I-CHAP) 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 ensure that their pediatricians/PCPs conduct periodic developmental assessments and if such assessments indicate developmental delays, the program facilitates referrals to the EIP component.
• Services for a referred child are provided by the Local Early Intervention Agency’s (LEIA) 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.

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

For information, please call the New York State Growing Up Healthy Hotline at 800-522-5006 (TTY/TDD: 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 a child from age 3 years up to their 21st birthday is identified as at risk for or having a developmental disability, pediatricians/PCPs shall, with parental consent, refer the child to the Committee on Special Education serving the school district in which the child resides. This program ensures such children are evaluated and receive needed special education and that disability-related health services are only 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. For more information, visit NYS Medicaid in Education.

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 Preauthorization 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 Preauthorization from the county health department.

For more information, please call the New York State Growing Up Healthy Hotline at 800-522-5006 (TTY/TDD: 800-655-1789) 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 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 Project TEACH, visit projectTEACHny.com.