Date Issued: 3/11/2015
On April 1, 2015, EmblemHealth will end its Electronic Data Interchange (EDI) agreement with Emdeon Business Services (Emdeon) to submit electronic claims to EmblemHealth, as well as to perform claims status and patient eligibility inquiries. This decision was made to reduce administrative and claims processing costs.
What You Can Do
You can choose to switch to another of EmblemHealth’s contracted claims clearinghouses or you may choose to remain with Emdeon. If your practice management system, vendor or third-party billing service uses Emdeon, please contact Emdeon to ensure they will forward your claims to one of the clearinghouse services for which EmblemHealth has trading partner agreements.
Below is a list of claims submission vendors or clearinghouses offering low-cost claims processing solutions for providers submitting electronic transactions to EmblemHealth. Please contact these vendors directly for information about their services, pricing and how to enroll. We, along with our vendors, are available to provide appropriate support to help you make a smooth transition before April 1, 2015. We will work with you to ensure that no interruptions occur in the submission of transactions.
|Vendor List for Professional and Institutional Submitters
|Vendor Name||Contact Name||Telephone|
|MD On-Line (Now part of the ABILITY Network)||Sales Department||1-866-855-4723||eh@ABILITYnetwork.com|
|Trizetto Provider Solutions
(Formerly Gateway EDI and Claim Logic)
|The SSI Group||Melissa Dixon
|Vendor List for Dental Submitters
|EDI Health Group, Inc DentalXChange
Looking Up Claims and Member Eligibility
You may also look up claims status and member eligibility information at no charge by signing in to the EmblemHealth website at www.emblemhealth.com/providers.
To check the status of a claim
- Select “Claims/Checks” from the left navigation panel or from the “How Can We Help You?” list.
- Select a plan type and category.
- You may search for a claim by data range, patient ID, claim number, check number or status.
- Select “Check Number” for claim detail information.
To check member eligibility
- Select “Benefits/Eligibility” from the left navigation panel or you may select “Check eligibility and benefits” from the “How Can We Help You?” list.
- Enter the member’s ID in the Patient ID Number Search box.
- Select “Search,” or
- Enter the member’s name in the “Patient Name Search” box.
- Select ”Search.”
- HIP providers may also enter a date in the “Choose Eligibility as of Date” box.
Note: To search eligibility for several members, you may enter multiple member ID numbers, separated by a comma in the “Patient ID Number Search” box, then select “Search.”
If you have any questions or would like to know more about connecting to EmblemHealth, please contact our EDI Help Desk at 1-212-615-4362, Monday through Friday, between 9 am and 5 pm (EST).