As you know, New York City employees, non-Medicare retirees, and their dependents are now offered the New York City Employees PPO (NYCE PPO) plan, a health plan delivered through a partnership between EmblemHealth and UnitedHealthcare. We encourage you to visit nyceppo.com for information, but there are some details we want to call out:
- NYCE PPO requires medical and behavioral health providers to use Payer ID 26992.
- Prime Therapeutics is the pharmacy benefit manager (PBM) for NYCE PPO. Review the NYCE PPO Provider FAQ for pharmacy authorization details.
- Members in EmblemHealth GHI CBP/Anthem BlueCross and BlueShield transitioned to the new NYCE PPO plan Jan. 1, 2026.
- If you are having trouble setting up your One Healthcare ID, there is a Help Center with key solutions. If necessary, contact support at 1-855-819-5909.
- New requests for preauthorizations should be directed to NYCE PPO. Providers should not contact Anthem for new preauthorizations beginning Jan. 1, 2026.
- Claims should be submitted as soon as possible after services are received, but no later than 180 days from the date of service for in-network providers or 18 months from the date of service for out-of-network providers.
- For providers in 13 downstate New York counties, NYCE PPO uses a custom version of The Bridge Program that combines the Prime Network and the National Network. That web page also includes a map and list of included counties.
For more information on the above points as well as how to submit your NYCE PPO claims, manage authorizations, or conduct other NYCE PPO-related services, review the NYCE PPO FAQ.