A dedicated page of useful materials you can give your EmblemHealth patients to help manage their care and keep their costs down.
Provider Toolkit
Provider Resources
Recently added
- 2025 Summary of Companies, Lines of Business, Networks & Benefit Plans
- 2025 Benefit Plans with No Referrals Required
- “Do I need a referral?” - A Quick Guide – Updated 10/25/2024
- Keep Your Directory Information Current
- EmblemHealth Neighborhood Care Physician Referral Form – Updated 08/01/2024
Welcome to EmblemHealth
Here is some information to help you get to know us and help you best serve our members, your patients.
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Provider Portal Training Materials
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Keep Your Directory Information Current
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2025 Summary of Companies, Lines of Business, Networks & Benefit Plans - Posted 10/25/2024
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2025 Benefit Plans with No Referrals Required - Posted 10/25/2024
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2024 Summary of Companies, Lines of Business, Networks & Benefit Plans
Last Updated: 07/22/2024 -
2024 Benefit Plans with No Referrals Required - Posted 11/8/2023
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Medicaid/HARP/CHP Programs
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Medicare Advantage Plans
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Commercial Networks and Benefit Plans
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Caring for Bridge Program Members
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EmblemHealth Guide for Electronic Claims Submissions
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Access and Availability Requirements
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Network Laboratories – Quest Diagnostics and Labcorp are our preferred clinical laboratories - Updated 4/10/2024
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Improving the Patient Experience
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ConnectiCare Members May Use Providers in the EmblemHealth Prime Network
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“How Do I…” Provider FAQs
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Frequently Asked Questions about Electronic Funds Transfer and Electronic Remittance Advice
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Notice of Privacy Practices
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“Do I need a referral?” - A Quick Guide - Updated 10/25/2024
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Network Laboratories – Quest Diagnostics and Labcorp are our preferred clinical laboratories - Updated 4/10/2024
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Quest Diagnostics
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EmblemHealth Neighborhood Care Physician Referral Form - Updated 08/01/2024
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New York Medicaid Statewide Patient-Centered Medical Home Incentive Program
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Compare Hospitals
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Skilled Nursing Facility Quality Guide
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New York State Nursing Home Profile
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DME Preauthorization Request Checklist
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Appointment Availability Standards During Office Hours & After Office Hours Access Standards
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CDC’s Recommended Immunization Schedules
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HEDIS/QARR Medical Record Review and Clinical Data Collection
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Medical Record Audits
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Medical Record Review Tools
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29-I Health Facility Billing Guidance
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29-I Health Facility Billing Tool
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Health Home Billing Guide
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EPO/PPO Corrected Professional Paper Claim Form
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National Provider Identifier (NPI) Reporting Sheet
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National Plan and Provider Enumeration System (NPPES)
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Unlisted Procedure Codes Form
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Assignment of Benefits Form
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National Government Services Policy Education Topics: Modifier 25
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Electronic Funds Transfer and Remittance Advice (EFT-ERA)
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Foster Care AND 29-I Transmittal Form
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Advise Your Patients to Visit Our Network Urgent Care Centers for Non-emergent Medical Care
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Medical Policies
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Medical Technologies Database
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Care Management Programs
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Occupational Health Clinic Joins EmblemHealth
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NYCDOHMH Primary Care Information Project (PCIP): Public Health Action Kits for Providers
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Information for Providers - Hepatitis C
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Domestic Abuse Guidelines
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New York City Domestic Violence Resources
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The Office for the Prevention of Domestic Violence
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Domestic Violence: Provider Resources
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ExerciseRewardsTM Program
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Free Services for You and Your Alzheimer’s Patients
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Health Care Proxy
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Health Survey for Adolescents
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Healthy Tips Teens Need to Know
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HIV/AIDS Case Management
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NYSDOH LGBT HIV Health
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Prenatal Program for Medicaid
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Provider Weight Management Resources
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Preventive Health Guidelines
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NYSDOH KIDS Performance Improvement – Provider Pocket Reference Guide
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Viral Infection Rx Pad
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Antibiotic Prescription Guide
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Mental Health and Substance Abuse
EmblemHealth strongly encourages care of the whole person. Please see screening tools and other valuable resources for the identification and treatment of mental health and substance abuse issues.
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Alcohol Abuse Screening Tool and Clinical Guidelines for Non-Mental Health Providers
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Behavioral Health Screening Toolkit for Primary Care Physicians
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Depression Screening Tool and Clinical Guidelines for Non-Mental Health Providers
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Formularies
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2019 Medicare Part D Opioid Policies: Prescriber Tip Sheet
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2019 Medicare Part D Opioid Policies: Prescriber Webinar
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EmblemHealth Medicaid Formulary
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High Risk Medications for Elderly Patients
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Medicare Requirement for Prescribing Part D Drugs
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Non-FDA-Approved Drug Use and/or Dose Request Form
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Physician Specialty Program Enrollment Form
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Potentially Inappropriate Medication Use in Older Adults
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Standing Orders for Influenza Vaccination and Other Vaccinations
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Prescribing eHealth Initiative Best Practices and Guidance
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Vaccines for Children (VFC)
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EmblemHealth Spine Surgery and Pain Management Therapies Program Guide
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Pain Management Prior Authorization Request Form
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Spinal Surgery Prior Authorization Request Form
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eviCore healthcare
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EmblemHealth Benefit Extensions Treatment Plan
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EmblemHealth Extension Request for a Current Authorization
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New York State Communicable Disease Reporting
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Assignment of Participating Provider Agreement to Health Insurance Plan of Greater New York (“HIP”)
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Managed Care Law of 2009
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Medicare Advantage Addendum
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New York State Standard Clauses - April 2017
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Special Provisions Related to Medicaid, CHIP and HARP Members
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Provider Checklist: Items Needed to Process Appeals
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EmblemHealth HDHP Programs ConsumerDirect EPO and ConsumerDirect PPO
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Home Incentive Program Practitioner Quick Reference
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Legislation Enacted To Increase HIV Testing in New York State
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Office of Health Insurance Programs Principles for Medically Fragile Children
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Provider Quality Measure Resource Guide
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Expired: 2024-2025 Annual Provider Notification
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Expired - Reminder: Keep Your Directory Data Current
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Expired: How To Keep Your Directory Data Current
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Expired: 2023 Summary of Companies, Lines of Business, Networks - Updated 10/11/2023
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Expired: 2023 Benefit Plans with No Referrals Required - Updated 2/10/2023
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Expired: 2023-2024 Annual Provider Notification
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Expired: 2022-2023 Annual Provider Notification
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Expired: 2022 Summary of Companies, Lines of Business, Networks and Benefits Plans
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2022 Benefit Plans That Do Not Require A Referral
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Expired: 2021-2022 Annual Provider Notification
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Expired: 2021 Summary of Companies, Lines of Business, Networks and Benefits Plans
Updated 06/16/2021
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Expired: 2021 Medicare Advantage Guide
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Expired: 2021 Benefit Plans That Do Not Require A Referral
Updated 04/15/2021
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Expired: 2021 Quality Measure Resource Guide
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Expired: 2021 Medicaid/HARP/CHP Resource Guide
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Expired: 2021 Summary of Companies, Networks & Benefit Plans
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Expired: 2021 Benefit Plans that Do Not Require a Referral
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Expired: 2021 Helping Outreach to Individuals Eligible for Health and Recovery Plans and Behavioral Health (BH) Home and Community Based Services
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Expired: 2020 Medicare Advantage Guide
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Expired: 2019 Network and Benefit Plan Updates
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Expired: 2018 Annual Plan News & Regulatory Reminders
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Expired: 2019 EmblemHealth Benefit Plans with No Referrals Required
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