October 2019 In The Know


Important information about your EFT accounts: Immediate Action Required

PNC has informed us that providers enrolled in electronic funds transfer (EFT) using multiple bank accounts for payments from EmblemHealth’s companies, have to reenroll in EFT. This does not apply to providers who use only one bank account.

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Required Medicare training due Dec. 15

CMS requires all Medicare providers to complete Special Needs Plan (SNP) Model of Care (MOC) training each year. Providers in the VIP Prime Network must complete the 2019 EmblemHealth SNP MOC provider training by Dec. 15. Look for a notice to arrive via email, fax, and postal mail with the user ID and PIN number needed to access the training online. Providers who prefer to download the training and an attestation form, may do so here. Providers who do not complete the training will be removed from the EmblemHealth Provider Directory.

Check panel reports – schedule new patient visits

If you’re a primary care provider (PCP), we urge you to regularly check your panel reports at emblemhealth.com/providers. This is especially important now as open enrollment begins, and new members select you as their PCP. Take a few minutes to review your reports to identify new patients and call them to schedule a new patient visit. Please encourage new Medicare and Dual Eligible Special Needs Plan (SNP) members to complete and submit their Health Risk Assessments, too.

New Medicaid benefits start Oct. 1

Children’s Home and Community Based Services (HCBS):

Children’s HCBS offers personal, flexible support services for children, youth, and families at home and in the community. An EmblemHealth care manager will help members get the services that are right for them.

See the HCBS benefits and the behavioral health benefits we began covering July 1.

Infertility Coverage: New York State has mandated changes for infertility benefits for Medicaid members. These changes are limited to female infertility and offers certain drug coverage. For details about infertility and the state's demonstration project, see the infertility information on the DOH website>.

Medicaid Health Home Benefits

Medicaid Health Home is a free care management program offered by the New York State Department of Health that helps eligible people stay as healthy as they can. Some of your Medicaid patients may be good candidates for the program if the meet the following criteria:

  • Two or more chronic conditions (e.g. mental health, substance abuse, asthma, diabetes, heart disease, and being overweight
  • Serious mental illness
  • A Health and Recovery Plan (HARP)

Ask your members who meet the criteria to contact us. Please provide them with a copy of this flyer that will give them additional information. Members can call 888-377-8277 from 9 a.m. to 5 p.m., Monday through Friday or email healthhomememberinquiry@emblemhealth.com for more information.

Medicaid: New York State Medicaid Update

We are happy to share with you the newest issue of Medicaid Update, a monthly publication from the Office of Health Insurance Programs of the New York State Department of Health. The August edition includes:


Policy and Billing Guidance

All Providers

If you missed a previous issue, or just want to review their archive, please visit the DOH Medicaid Update page


Bridge Network and New Claims Payment Process

The Bridge Network is a new name that combines some of the existing EmblemHealth or ConnectiCare commercial networks. A guide for managing these members has been posted to the Provider Toolkit.

For the new ASO funding arrangement, PNC Bank is partnering with ECHO Health, Inc. to fund and pay claims. It is a different system from that used for other EmblemHealth EFT payments and you need to enroll separately with ECHO for EFT or paper check payments. The Payor ID appearing on members’ ID cards utilizing the Bridge Network for their services is 10000006. Payments will be made by a virtual credit card unless there is a different payment method on file with ECHO Health. If you have questions regarding your payment options, please contact ECHO at 888-492-0032.


Reminder: Follow new site-of-service pre-authorization list for HIP’s commercial and medicaid members

The new site-of-service pre-authorization list became effective Sept. 1.

Please click here for other UM pre-authorization changes effective Jan. 1, 2020.

Medical Policy Updates

This month’s update includes revisions to the following medical policies: Bone Mineral Density Studies in Adult Populations, Cryosurgical Ablation for Prostate Cancer, Dorsal Column Stimulator for Pain Management, Acupuncture, Prostatic Urethral Lift (PUL). To see details, click here.

Medical technologies database updated September 2019

To see the latest updates, click here.


EmblemHealth updates its Formulary on a regular basis. Find our most recent updates here here.


Do you have new office staff? Join us Oct. 9 for our monthly webinar

Practitioners and office staff are welcome to join our monthly webinar that provides an overview of our products and benefit plans, special utilization management programs, and how to navigate our provider portal. Sign up for our next session to be held Oct. 9 at 10 to 11 a.m. or 2 to 3 p.m. Space is limited, Register today.
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