Join Our Network

Why Choose EmblemHealth?

EmblemHealth and our companies have a single overriding mission: To provide affordable, quality health care to all of our members. We are proud of a tradition of providing helpful information and prompt, responsive service to our members, of giving your patients many plan options, and of our partnerships with health care professionals.

If you would like to join the thousands of physicians and clinicians who are partnering with EmblemHealth, please follow the instructions below.

Joining Our Networks

EmblemHealth partners with various organizations to give our members the benefit of value-based care, administrative efficiencies and specialized expertise. Where appropriate, EmblemHealth has entered into agreements with these partners to perform credentialing on EmblemHealth’s behalf. EmblemHealth has a stringent oversight processes to ensure these partners meet our high standards. In certain circumstances, health care professionals are required to sign direct agreements with these partners and go through their credentialing processes.

Depending on your specialty, you may need to apply for participation through one of EmblemHealth’s partners. Based on your specialty, click on the link below to get more information about credentialing. If your specialty is not listed, download and complete the EmblemHealth credentialing documents under “Before You Apply”.

 

Musculoskelal Services (Physical Therapy, Occupational Therapy, Chiropractic)
EmblemHealth has partnered with Palladian Muscular Skeletal Health (Palladian), a specialty network and utilization management organization, to arrange chiropractic or physical and occupational therapy services for our members. Through this partnership, Palladian is responsible for credentialing and recredentialing for HIP. EmblemHealth EPO/PPO and GHI PPO providers contract directly with the plan.

 

Please refer to the chart below:

Benefit Plan Palladian EmblemHealth
GHI HMO Yes  
HIP Yes  
EmblemHealth EPO/PPO   Yes
Medicare Choice PPO   Yes


For further information on credentialing with Palladian, contact Palladian’s Customer Service at 877-774-7693.

 

Behavioral Health

(Applied Behavior Analysis, Psychiatry, Psychology, Counseling, Psychiatric Nurse)
EmblemHealth has partnered with Beacon Health Options to manage behavioral health and substance use services for our members. Through this partnership, Beacon Health Options is responsible for provider credentialing and recredentialing. For more information, contact the Beacon Health Options National Provider Line at 800-397-1630 from 8 a.m. to 8 p.m.

For more information about our partnership with Beacon Health Options, please see the Behavioral Health Services chapter of our Provider Manual.

 

Dental

EmblemHealth has partnered with DentaQuest to manage the dental benefits. Through this partnership, providers contract directly with DentaQuest. Go to DentaQuest for more details or call DentaQuest at 844-822-8108, Monday to Friday from 8 a.m. to 5 p.m.

 

Vision Service Providers

EyeMed is responsible for the provider network covering routine vision and hardware services , including contracting and credentialing, claims processing and payment, routine vision grievances and claims appeals.* Please note: Medical vision services are still contracted directly with EmblemHealth or other applicable delegate.

If you are Interested in Joining EyeMed, complete an online interest form or call EyeMed’s provider service department at 800-521-3605.

*Exception: Medicare grievances and claim appeals will continue to be managed by EmblemHealth.

 

There are exceptions to these partnerships, if you are part of Health Care Partners, Montefiore CMO, a federally qualified health center or a diagnostic and treatment center please contact your Administrator regarding participating with EmblemHealth.

To see if your organization has been delegated for credentialing, please review this list. If your organization is on the list, please contact your administrator to discuss inclusion in EmblemHealth’s networks.

This applies to:

  • Community Health Centers
  • Federally Qualified Health Centers
  • Diagnostic and Treatment Centers

To help us credential new clinicians quickly, efficiently and accurately, your application must be complete and contain current information about the clinician(s) you seek to credential. Please review this checklist before submitting your next provider credentialing application to us.

CAQH® Application

Make sure your clinician(s) enroll with CAQH® and that his/her credentialing information is current on the Provider Application. Before submitting it to EmblemHealth, check to make sure the information is complete and up to date. You are required to validate the accuracy of the service and billing addresses before sending in your application.

At EmblemHealth, we validate the accuracy of your addresses through phone calls. Locations found to have inaccurate information will be denied participation. This also includes the accuracy of the service address. We will check that the provider takes patients at that address and that the phone number given is for scheduling patient appointments.

Review and complete all of the required information. If any of the following is missing or incomplete, the application will be returned. The provider cannot be credentialed until a complete application is submitted.

The items below items may not include all required fields for the CAQH system. This lists data elements that are frequently missing and that prevent an application from being processed.

  1. Information you must provide
    • Section 1:
      • Provider Type
      • Name
      • Gender
      • Date of birth
      • All professional and other IDs and expiration dates
    • Section 3:
      • Primary Specialty for which you are licensed that you will be practicing
    • Section 4:
      • Primary Practice Location including the tax ID to use for this provider (group or individual). Please only list service locations to appear in provider directories; for which the provider practices and takes patient appointments.
      • Must check the box to indicate electronic capabilities.
      • Payment and remittance information must be provided – even if you check the box, you must provide the email address of the payee contact.
      • Office hours
    • Section 5:
      Admitting arrangements Hospital Privileges
      • You must be affiliated or have coverage arrangements with at least one participating hospital in order to be credentialed with EmblemHealth. Provider types not required to have hospital privileges are: acupuncturists, allergists, anesthesiologists, audiologists, chiropractors, dentists, dermatologists, geneticists, nutritionists, occupational therapists, optometrists, pathologists, physiatrists, podiatrists, radiologists, physical therapists, physician assistant, speech and language pathologists.
        1. If yes: all requested information must be completed
        2. If no: indicate how patients will be admitted, i.e., enter the covering provider’s name and email address. Please note: the covering provider must be participating with the same EmblemHealth network and admit to an EmblemHealth participating hospital.
    • Section 6:
      • Professional liability insurance carrier – All requested information must be completed and up to date – with an active policy in place (must not be expired). Ensure completion of the professional liability insurance section including your name, “To” and “From” dates, policy number and coverage limits (minimum $1 million per occurrence/$3 million aggregate), or accompanying roster from the agency/carrier with policy number and coverage limits. CAQH needs to be updated with the current account number and expiration dates of coverage.
    • Section 7:
      • Work history and references. Provide a full account of your work history for the past five years in a month/year format. This includes current employment if provider has already started with current practice. If you have had an employment gap of six months or more in your supporting documentation, you must submit an explanation as to why the gap occurred. This would include a six-month gap between completion of training and employment start date.
    • Section 8:
      • Disclosure Questions
      • If you have any open or closed malpractice cases within the last 10 years, provide an explanation regarding your malpractice claims history, including the reason for the claim(s) and their disposition.
  2. Upload current copies of the following items under “Documents” section of the CAQH application:
    • NYS DEA certificate*
    • NYS license registration certificate*
    • Malpractice face-sheet/Certificate of Liability Insurance
    • Signed & dated W9 for applicable TIN# - Please ensure a copy of the W-9 form applicable for the tax ID affiliated with each service location on your application is attached or uploaded as supplemental documentation. Please note: only one W-9 form is needed per tax ID.
    • CAQH authorization and release form (must be signed within 120 days of the application submission)

      Also remember to place a check mark in all applicable boxes and answer the questions to the checked box, if applicable).
  3. Save all changes to the CAQH application and reattest. Please note: Attestations for EmblemHealth can't be more than 120 days old.

 

In addition to the CAQH application, EmblemHealth requires clinicians to submit additional documents as follows:

  • Non-Delegated Application Spreadsheet
  • Group Roster
  • Covering Provider agreement (if no current hospital privilege is recorded in CAQH)
    • This may include a Transfer Agreement between the group and hospital
    • This may include a Linkage Agreement between the group and hospital
  • PA credentialing application (addendum for Physician Assistants)
  • NP credentialing application (addendum for Nurse Practitioners)
  • NP Collaborative Relationships Attestation form (Applicable to NP’s with More than 3600 Hours)
  • NP Collaborative Agreement (Less than 3600 Hours, if applicable)
  • Signed/dated W-9
  • ADA attestation (must use the EmblemHealth’s form) – one for each location (Please note: an ADA attestation is not needed for GHI PPO.)

PA credentialing application (addendum for Physician Assistants)

NP credentialing application (addendum for Nurse Practitioners)

* Item not needed but make sure you complete the section of the application by giving the ID numbers for your DEA certificate and NY State license certificate.

You are now ready to submit your credentialing application. Once all of the above is completed, email your participation request(s) to your EmblemHealth Representative.

Please note: Discontinue use of any Initial Application Credentialing Checklists you may have previously used. The Credentialing Checklist is for INTERNAL USE ONLY and will not be accepted.

The following Document Checklist will help you verify that you have attached all required documents to your email before sending.

before you apply

Credentialing EmblemHealth Applicants

Credentialing is a process which reviews and verifies a practitioner's training and qualifications prior to that practitioner being approved for participation with a health plan. Specific criteria are applied in determining participation in our networks. Every three years, practitioners are required to be re-credentialed in accordance with NCQA guidelines. The recredentialing process ensures that the provider's credentials are up-to-date and accurate.


Credentialing and Recredentialing Forms

At a minimum, you will need to complete and submit the following forms for the credentialing and recredentialing processes:

  • Provider Recruitment Checklist

  • CAQH Tips

  • PPO Agreement

  • Provisional Credentialing Attestation Form

  • Americans With Disabilities Act (ADA) Attestation

  • Form W-9

  • Dental Provider Application

  • Dentist Application


Supplemental Forms for Credentialing and Recredentialing

Below are supplemental forms you may also need

  • Professional Liability History

  • Hospital Coverage Arrangements Attestation

  • Hospital Privileges and Malpractice Attestation Form

  • Credentialing Application Addendum for Registered Physician Assistant

  • Credentialing Application Addendum for Nurse Practitioner

  • Advanced Nurse Practitioner Requesting Additional Status as Primary Caregiver

  • Disclosure Certification Form (Medicaid Providers Only)

EmblemHealth requires all applicants for all networks to complete the Council for Affordable Quality Health Care (CAQH) Proview credentialing application form. If you do not have a CAQH number, please register with CAQH ProView. If you have any  questions abouthow to obtain a CAQH number, please call  CAQH at 1-888-599-1771.

To join the GHI PPO or EmblemHealth EPO/PPO National Network, please make sure you have reviewed the “Credentialing EmblemHealth Applicants” section above.

Our network in Florida is closed except for primary care physicians, cardiologists, orthopedic surgeons and any provider that is joining a group that is already participating with EmblemHealth. The network outside of New York, New Jersey, Connecticut and Florida is currently closed unless the provider is joining a participating group. To join the GHI PPO or EmblemHealth EPO/PPO National Network, please make sure you have reviewed the “Credentialing EmblemHealth Applicants” section above.

Sending Your Application

For New York City, including Nassau and Suffolk counties, as well as New Jersey and Connecticut applicants, please send your completed application and agreements to:

EmblemHealth 
55 Water Street 
New York, NY 10041 
Attn: Physician Contracting, 7th floor

For all other counties in New York State and Florida as well as providers in other states joining a participating group, please send your completed application and agreements to:

EmblemHealth 
5015 Campuswood Drive 
East Syracuse, NY 13057 
Attn: Physician Contracting

Please note: All applications must be sent along with the corresponding signed agreement for the networks you are electing to join.

Practitioner Rights

Please be aware, during the credentialing process, practitioners maintain the following rights:

  • The right to review information obtained in support of their credentialing applications, excluding references, recommendations or other peer review protected material.
  • The right to correct erroneous information in written form to the credentialing department within 10 days of receipt of EmblemHealth's notification. This may include: actions on licensure, malpractice claims history and board certification status.
  • The right to be informed of the status of his/her credentialing/recredentialing application. Requests may be made to EmblemHealth via written or telephone inquiry. Response will be made within 10 days of receipt, via same communication method as the original inquiry.