To help improve the management of our membership and drive positive customer experience, EmblemHealth is partnering with HealthCare Partners (HCP) to merge the HCP Cohort 2 program with Cohort 1 starting Oct. 1, 2021. We recently sent invitations to affected providers to contract directly with HCP to continue caring for members under the Cohort 1 Program.
What this means is, after Oct. 1, utilization and care management (referrals, preauthorizations, ER admission notifications) and claims processing will all be handled by HCP. Providers who decline HCP’s invitation will continue participation under their direct agreements with Health Insurance Plan of Greater New York (HIP) or agreements via HIP Network Services, IPA. Care for members assigned to these primary care providers will follow EmblemHealth’s utilization, care management and claims processing rules.
Be sure to check eligibility for all members in the provider portal which will indicate the managing entity. If you see HCP as the “Assigned Managing Entity” in the provider portal after Oct. 1 or the HCP logo on a member’s ID card, follow the HCP Cohort 1 protocols. Participation in special Utilization Management Programs will also follow Cohort 1 rules.
If you have questions or need assistance, call HCP at 516-941-2160, from 8:30 a.m. to 5 p.m. Monday through Friday.
To see the HCP logo, as well as other managing entity logos, please visit the Provider Manual’s Member Identification Cards chapter, Sample ID Card tab.