On March 16, 2015, EmblemHealth finalized negotiations for a nonexclusive agreement with Emdeon Business Services to provide EDI transactions. Emdeon will continue to submit EDI transactions to EmblemHealth in accordance with the new agreement.
We have added Emdeon to the list of claim submission vendors and clearinghouses listed below. All the listed vendors or clearinghouses offer 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. Please note that no interruptions will occur in the submission of claims 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
|Emdeon Business Services||Sales Department
|Vendor List for Dental Submitters
|EDI Health Group, Inc DentalXChange
|Emdeon Business Services
||Sales Department||1- firstname.lastname@example.org|
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).