Your source for important provider news and updates.
January 2026
Office Visit
As we start another new year, we want to continue to support our providers in caring for our members to help deliver the best health outcomes possible. Understanding our plans is critical to that effort. Please review the following key resources we’ve prepared to make it simpler for you and your patients to navigate our plans.
Our annual provider notice has everything you need to work with us this year, including guidance on caring for our City members under the New York City Employees PPO (NYCE PPO) plan. Other helpful resources and reminders include:
- New Pharmacy Benefit Manager: Prime Therapeutics.
- Pharmacy Medical Preauthorization List.
- EmblemHealth Medicare Advantage Plans.
- EmblemHealth Commercial Networks and Benefits Plans.
- 2026 Benefit Plans With No Referrals Required.
- Importance of Using Participating Labs.
- Preauthorization List - See Notable Changes.
We look forward to working with you this year as you deliver care to our members.
As you know, New York City employees, non-Medicare retirees, and their dependents are now offered the New York City Employees PPO (NYCE PPO) plan, a health plan delivered through a partnership between EmblemHealth and UnitedHealthcare. We encourage you to visit nyceppo.com for information, but there are a couple of details we want to call out:
- NYCE PPO requires medical and behavioral health providers to use Payer ID 26992.
- Members in EmblemHealth GHI CBP/Anthem BlueCross and BlueShield transitioned to the new NYCE PPO plan Jan. 1, 2026.
- New requests for preauthorizations should be directed to NYCE PPO. Providers should not contact Anthem for new preauthorizations beginning Jan. 1, 2026.
- Claims should be submitted as soon as possible after services are received, but no later than 180 days from the date of service for in-network providers or 18 months from the date of service for out-of-network providers.
- For providers in 13 downstate New York counties, NYCE PPO uses a custom version of The Bridge Program that combines the Prime Network and the National Network. That web page also includes a map and list of included counties.
For more information on the above points as well as how to submit your NYCE PPO claims, manage authorizations, or conduct other NYCE PPO-related services, review the NYCE PPO FAQ.
February is American Heart Month and the month of love. Encourage your patients to give their hearts the love they need. Recommend a heart-healthy lifestyle and engage patients managing cardiovascular disease to be proactive in their own care.
To help reduce the risk of heart attack or stroke, the American Heart Association recommends statins of moderate or high intensity for adults with clinical atherosclerotic cardiovascular disease.
Here are a few tips to support statin use for patients with cardiovascular disease:
- Discuss why they are on a specific statin medication and explain the role and importance of statin therapy.
- Identify and help resolve patient-specific barriers to medication adherence or concerns, such as adverse side effects or cost.
- Recommend mail order and/or a 90-day prescription of maintenance drugs.
Statin therapy is only one aspect of care for patients with cardiovascular disease but has a significant impact on measuring overall effectiveness of care. For patients who have experienced a cardiac event (heart attack, heart transplant, etc.), strong evidence shows that cardiac rehabilitation can significantly improve functional status and other important health factors.
Cardiac rehabilitation consists of the following, which are often covered by health insurance plans and federal programs:
- Exercise counseling and training.
- Education for heart-healthy living.
- Counseling to reduce stress.
- Maintaining healthy blood pressure.
HEDIS Tips for Controlling High Blood Pressure
The Controlling Blood Pressure (CBP) measure is for patients 18 to 85 years old who had a diagnosis of hypertension and whose blood pressure (BP) was adequately controlled. The BP must be less than 140/90. To monitor the CBP, you can:
- Document the BP at each visit.
- Indicate the date the BP was taken.
If the initial BP is greater than 140/90, retake the patient’s BP at the end of the visit. If the BP remains elevated, ensure the patient returns for a repeat BP reading in at least two weeks.
It’s never too early to start focusing on a child’s oral health. The American Association of Pediatric Dentists recommends that parents establish a dental home for their child by their first tooth or first birthday. During this time, parents/guardians will have the opportunity to ask questions and address any dental concerns at the primary visit, and the dentist will gently swab the child’s mouth to check their gums and any erupted teeth. As the child starts teething, the dentist will be able to monitor their progress and implement preventive measures for any concerns with your baby’s teeth.
The American Dental Association (ADA) is pleased to provide you with the February 2026 National Children’s Dental Health Month (NCDHM) Program Planning Guide and brushing calendar. This month-long national health observance brings together thousands of dedicated dental professionals, health care providers, oral health champions, and others to promote the benefits of good oral health and prevention to children and adults, caregivers, teachers, and many others. For more information including this year’s theme and patient resources including an interactive brushing calendar, visit the ADA website for information on National Children’s Dental Health Month.
JP70916