Provider Manual

Chapter 4: Member Identification Cards

Members and their spouses and dependents, age 19 and older, receive a member identification (ID) card. The card provides members and providers with important health plan information, including covered riders and copayments. Please note, for HIP-underwritten plans, each dependent child under age 19 will receive his or her own personal ID card.

 

All Enhanced Care Prime Network and Child Health Plus members will receive their own personal member ID cards.

 

Unique non-Social Security number-based identification numbers are issued to our members to protect their confidentiality. This practice also protects our members from potential identity theft and fraud. All Medicaid members receive their own personal member ID card that includes a unique Medicaid Client Identification Number.

 

Diagrams to help you quickly locate key coverage details and contact information when inspecting a member ID card appear in the “Sample ID Cards” section of this chapter.

 

Ask to see a member’s ID card at each appointment, emergency visit, or inpatient stay. Do not make a decision to provide care only on whether a member has a member ID card. A member ID card does not guarantee eligibility or payment of benefits. Providers should verify member eligibility on our secure website at emblemhealth.com/providers.

 

Providers should verify member eligibility as outlined in the chart below.

Confirm Member Eligibility

Provider Network

Instructions
(Choose one of the bulleted options)
Have your TIN ready before calling the IVR system

Select Care Network

Prime Network

Enhanced Care Prime Network

VIP Prime Network

  • Check eligibility at emblemhealth.com
    • PCPs may also check their Panel Reports
  • Speak to a representative or call the IVR phone system at 866-447-9717
  • Providers with eMedNY access may check the enrollment of their Medicaid members on ePACES.
CBP, National & Tristate Networks

Network Access Network
  • Check eligibility at emblemhealth.com
  • Speak to a representative or call the IVR phone system: 
    NYC: 212-501-4444 
    Outside NYC: 800-624-2414
Medicare Choice PPO Network
  • Check eligibility at emblemhealth.com
  • Speak to a representative or call the IVR phone system at 866-557-7300

This section includes a helpful guide to member ID cards that you may see for members enrolled in our various plans. These are examples of the templates we use on the dozens of member ID cards in circulation. These diagrams are meant to help you quickly locate key coverage details and contact information when inspecting a member’s ID card, but do not capture all the information you may see. Please refer to the member’s ID card presented at the point of service for specific addresses, telephone numbers, plan names, plan restrictions etc. Member ID cards may also contain logos for managing entities or extended networks that affect utilization management, member access to specific networks, and more. A list of these managing entities and networks, as well as some important information about each, appears below the Member ID diagrams.

Please note: This first example is an ID card template used for most EmblemHealth Plans, including the new Affinity plans introduced in 2019. It is likely to be the most common design you will see, though the information on each card will be customized to the member’s plan and benefits.

EmblemHealth VIP Value I.D. Card
NYC Gold I.D. Card
NYC GHI CBP I.D. Card
Empire BCBS I.D. Card
ConnectiCare I.D. Card

Managing Entities and Extended Networks

Bridge Network: Members who have the Bridge Network on their member ID cards belong to self-funded employer groups for which EmblemHealth and ConnectiCare are providing administrative services and access to our commercial networks. For information on the Bridge Network, click here. To see the quick reference guide which includes an image of a Bridge Network Member ID card, click here.

ConnectiCare: Some members who access care through the Prime Network may also access care through ConnectiCare in Connecticut. Similarly, some ConnectiCare members may access care through EmblemHealth’s Prime Network. See the 2019 Provider Networks and Member Benefit Plans chapter for applicable plans.

HealthCare Partners: The member is assigned to an HCP primary care physician. The managing entity is responsible for utilization management for assigned members.

Montefiore Medical Center: The member is assigned to a Montefiore primary care physician. The managing entity is responsible for utilization management for assigned members.

PHCS/MultiPlan: Members in the National Network have access to PHCS/MultiPlan outside of New York.

QualCare: Certain members in the Prime Network have access to QualCare’s network in New Jersey. Likewise, HMO members have access to the QualCare HMO network; other plans have access to QualCare PPO network. See the 2019 Provider Networks and Member Benefit Plans chapter for applicable plans.