Claims Contacts

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Paper Claims
Managing Entity Partners
Vendor Partners
Additional Claim Partners

Paper claims (CMS 1500 and UB-04 forms) may be sent to the addresses indicated, unless otherwise noted on the member's ID card.

Company	Network	Type of Claim	EDI or Payor ID	Clearing House	Paper Claim Submission Address	Contact for Inquiries
HIP / EmblemHealth Insurance Company (formerly HIPIC)	Bridge Enhanced Care Prime Prime VIP Prime Bold Reserve Millennium Select Care	Professional claims	HIP/ EmblemHealth Insurance Company: 55247 HIP plans branded GHI HMO: 25531 HIP plans branded Vytra HMO: 22264	Vendor or direct submission	EmblemHealth PO Box 2845 New York, NY 10116-2845	emblemhealth.com/providers or 866-447-9717
HIP / EmblemHealth Insurance Company (formerly HIPIC)	Bridge Enhanced Care Prime Prime VIP Prime Bold Reserve Millennium Select Care	Facility claims	HIP/HIPIC/ Bridge: 55247 HIP plans branded GHI HMO: 25531	Vendor or direct submission	EmblemHealth PO Box 2803 New York, NY 10116-2803	emblemhealth.com/providers or 866-447-9717
EmblemHealth Plan, Inc. (formerly GHI)	Bridge CBP Tristate National Network Access Medicare Choice	Professional claims, member-submitted	13551	Vendor or direct submission	EmblemHealth PO Box 3000 New York, NY 10116-3000	emblemhealth.com/providers or 212-501-4444
EmblemHealth Plan, Inc. (formerly GHI)	Bridge CBP Tristate National Network Access Medicare Choice	Professional claims, provider-submitted	13551	Vendor or direct submission	EmblemHealth PO Box 2832 New York, NY 10116-2832	emblemhealth.com/providers or 212-501-4444
EmblemHealth Plan, Inc. (formerly GHI)	Bridge CBP Tristate National Network Access Medicare Choice	Facility claims	13551	Vendor or direct submission	EmblemHealth PO Box 2833 New York, NY 10116-2833	emblemhealth.com/providers or 212-501-4444
EmblemHealth Plan, Inc. (formerly GHI)	GHI PPO Dental	Dental claims	Not applicable	Vendor or direct submission	EmblemHealth PO Box 2838 New York, NY 10116-2838	emblemhealth.com/providers or 212-615-4EMC
ConnectiCare	Choice Passage	CCI Medicare Advantage claims	78375	Vendor or direct submission	ConnectiCare PO Box 4000 Farmington, CT 06034-4000	877-224-8230
ConnectiCare	Choice Flex	CCI commercial claims	06105	Vendor or direct submission	ConnectiCare PO Box 546 Farmington, CT 06034-4000	800-251-7722

(Applicable to Health Insurance Plan of Greater New York (HIP) only)

Company	Network	Type of Claim	EDI or Payor ID	Clearing House	Paper Claim Submission Address	Contact for Inquiries
HealthCare Partners (HCP)	Enhanced Care Prime Prime VIP Prime Bold Reserve	HIP claims for members managed by HCP	11328	Vendor	HealthCare Partners Attn: Claims Department 501 Franklin Avenue Suite 300 Garden City, NY 11530-5807	516-746-2200 or 888-746-2200
SOMOS	Enhanced Care Prime	For Medical Claims – Medicaid/CHP/HARP and Essential Plan	81336	Vendor	SOMOS IPA, LLC., P.O. 211473 Eagan, MN 55121	844-990-0255

Company	Network	Type of Claim	EDI or Payor ID	Clearing House	Paper Claim Submission Address	Contact for Inquiries
eviCore	Bridge Enhanced Care Prime Prime VIP Prime Bold Reserve Tristate National Network Access Medicare Choice	For the Outpatient Diagnostic Imaging Privileging for Non-Radiologists, Radiology, Cardiology Imaging, and Radiation Therapy Programs: -eviCore contracted providers, please submit claims directly to eviCore. -All others, please submit claims to EmblemHealth as indicated above.	14182	Vendor/Relay Health	eviCore PO Box 677 Lake Katrine, NY 12449	866-221-8787 Option 2
Carelon Behavioral Health (formerly Beacon Health Options)	Bridge Enhanced Care Prime Prime VIP Prime Bold Reserve Emblem CBP Tristate National Network Access Medicare Choice CBP Tristate National Network Access Medicare Choice	Behavioral Health Services Program Submit claims to Carelon. Providers who are not in Montefiore’s network, submit claims to Carelonfor Montefiore members and all other Carelon-managed members. EmblemHealth Behavioral Management Program Submit claims to Carelon.	FHC & Affiliates Vendor	Vendor	EmblemHealth PO Box 1850 Hicksville, NY 11802-1850	Carelon Behavioral Health or 800-235-3149
Empire	CBP	City of New York GHI PPO Claims for facility and other services managed by Empire				800-433-9592
EyeMed	All	For all members with routine vision care benefit			EyeMed 4000 Luxottica Place Mason, Ohio 45040	eyemed.com Medicare: 844-790-3878 Medicaid: 877-324-2791 Commercial (HMO, PPO, POS): 877-324-4063 On/Off Individual and Group Exchange and Essential Plans: 877-324-6211
Healthplex, Inc.		For the HIP plans supported by Healthplex where there is a dental benefit claim	52133		Healthplex PO Box 30605 Salt Lake City, UT 84130-0605	888-468-2183

Company	Network	Type of Claim	EDI or Payor ID	Clearing House	Paper Claim Submission Address	Contact for Inquiries
PNC	All	HIP & GHI Medical and Hospital claims prior to transitions to ECHO Health, Inc.	See EmblemHealth section above.	PNC Remittance Advantage	N/A	800-630-3060, option 1 support@jopari.com
ECHO Health, Inc. (ECHO)	All	All claims after the transitions from PNC.	See EmblemHealth section above.	ECHO	See EmblemHealth section above.	888-492-0032 888-834-3511, option 3

Company

Network

Type of Claim

EDI or Payor ID

Clearing House

Paper Claim Submission Address

Contact for Inquiries

PNC

All

HIP & GHI Medical and Hospital claims prior to transitions to ECHO Health, Inc.

See EmblemHealth section above.

PNC Remittance Advantage

N/A

800-630-3060, option 1
support@jopari.com

ECHO Health, Inc. (ECHO)

All

All claims after the transitions from PNC.

See EmblemHealth section above.

ECHO

See EmblemHealth section above.

888-492-0032

888-834-3511, option 3

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Claims Contacts