Provider Portal Update
Billing Companies and Out-of-Network Providers Must Use the Portal To Receive Service.
As part of our commitment to supporting an all-digital approach to managing health care, beginning Oct. 1, 2023, billing companies will, as a prerequisite to speaking with a Provider Customer Service representative, be required to first submit a message through our provider portal.
If a response is not received within two business days, only then may the billing companies call Customer Service. Billing companies will need to provide the Message ID from the portal to the customer service representative before the representative can continue with the call.
Furthermore, as of Oct. 1, out-of-network (OON) providers will only be able to message us through our portal and will only have access to the portal after submitting a claim and registering for a portal account. More information on this process will be published before Oct. 1. OON providers may use our IVR to check claim status, authorization and referral status, as well as member basic benefits and eligibility after entering the Member’s ID number and date of birth in the IVR. The only exception for speaking to a customer service representative is when OON providers need to request a medical or pharmacy authorization.
How will the portal save you time?
We encourage all our providers to use the portal for communicating with us. If you aren’t sure how, here’s where you can find more information. How will the portal save you time and effort? Documents submitted through the portal are all stored together. This means our staff can start working on issues without waiting for documents to be sent, scanned, and matched to the case. This significantly shortens the cycle time to resolution and shortens the time for you to get your answers.
How do you set up your billing company?
Make sure your portal administrator properly sets up your billing company staff with Billing Specialist portal accounts for your Tax ID(s), See the portal training material links below to find the correct guide to this process. If the billing company does not have someone to do this, you may need to assist them. To help with this, we have videos and guides on our websites with step-by-step instructions on how to get portal access and add, remove, and manage users.
New Live Agent Chat feature coming soon
In the coming months, we will also offer live agent chat on our provider portal. This feature will allow you to ask real-time questions with an agent, improving your own and your billing company’s experience with the portal.
More benefits of the portal
If you have not started using our portal, you should know it is an efficient and effective way to conduct your ConnectiCare and EmblemHealth business. Whether it is submitting preauthorizations online, checking member eligibility, making inquiries, submitting medical records, or looking up claims, our portal is a superior alternative to phone, fax, and regular mail.
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