Office Visit

OrthoNet LLC, which is part of Optum Health, reviews preauthorization requests for EmblemHealth's Spine Surgery and Pain Management Therapies Program for select spine surgery and interventional pain management therapy. 

The OrthoNet portal will be discontinued on Sept. 3, 2025. EmblemHealth providers will need to submit preauthorizations via Optum’s Spine, Pain, and Joint portal. 

To use the Optum portal, providers need a One Healthcare ID (OHID) account as we announced in April. If you already have an OHID account, you’ll be able to sign in to the portal using your current credentials. If you do not have credentials, please register for an account here. For questions about your Optum provider ID and password, please contact Optum Health Services at 844-730-8503 from 9 a.m. to 6 p.m., Monday through Friday. 

Other important notes

Physical letters will no longer be mailed starting Sept. 3, 2025. However, you can access letters using the Optum portal. Please also note that the address on provider letters will be changed to: 

Optum, P.O. Box 5600, Kingston, NY 12402-5600.

You will receive another notification 30 days prior to the portal change. This will include more information about portal changes, sign-in instructions, and portal usage guides. 

For all other questions, please contact your network account manager or sign in to emblemhealth.com/providerportal and use our live agent chat or Message Center. A provider Customer Service representative will be happy to help. 

We appreciate your continued partnership in caring for our members.

EmblemHealth is committed to providing comprehensive care for all our members; especially underserved pregnant members and those with high-risk pregnancies.

Our dedicated Care Management team will be sending a questionnaire to our Medicaid and Health and Recovery Plan (HARP) members ages 18-45 to help identify those at high-risk who can benefit from individual care management. 

Our Healthy Futures Program is a great resource that connects members with important health information, so they feel supported through their pregnancy journey. If you have pregnant members you want to refer to our Healthy Futures care management program, please call us at 888-447-0337 from 9 a.m. to 5 p.m., Monday through Friday. Together, we can help create healthier futures for our members and your patients.

Summertime, when pediatric office visits are typically low, is a good time to get your young patients up to date on their vaccines, immunizations, and boosters. 

As you know, children, preteens, and teens have specific vaccination requirements and certain immunizations are recommended at specific ages. As they visit your office to comply with school or day care requirements, talk to their parents about the importance of vaccinating their children and help improve immunization rates. 

For children who may not have been to your office in a while, reach out to their parents and encourage them to schedule an appointment for their child.

Here are some helpful tips to engage with parents. 

• Review and ensure accurate and thorough chart preparation before the appointment.
• Review charts for immunization gaps.
• Educate your care teams about scheduling visits within the guideline time frames.
• Continue to ensure at each appointment (even sick visits), that immunization records are reviewed and encourage them to catch up on missed immunizations.
• Advise parents on the importance of timely completion of each vaccine series. 
• Provide handouts on the diseases/illnesses that the vaccines prevent.

Follow the guidelines for ages 7 to 18 and 6 and under and see more information and resources on childhood immunizations and health activities on the Centers for Disease Control and Prevention (CDC) website. Your influence is key in the development, health, and well-being of children.

This is a quality measure based on the American Academy of Pediatrics Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents (published by the National Center for Education in Maternal and Child Health).

WellSpark Health’s broad range of well-being resources are helping our members achieve positive behavioral and lifestyle changes. We ask that you encourage eligible members to sign in to the member portal to see what is available to them and take advantage of the support offered.

One member, a 60-year-old female with high blood pressure, turned to health coaching for support and accountability. She had this to say about the program, “Through coaching I was able to let go of my all-or-nothing mentality and focused on making small changes. I have lost 24 pounds since working with my coach and I am only three pounds away from my 50-pound goal.”

To see which of our benefit plans offer WellSpark’s resources, review the 2025 Summary of Companies, Lines of Business, Networks & Benefit Plans.

See revision histories for the updates to the following lists:

• GHI PPO City of New York Preauthorization List.
• The Pharmacy Medical Preauthorization Lists for EmblemHealth and ConnectiCare.

EmblemHealth’s Medical Policy Updates

EmblemHealth updated the Medical Necessity Guidelines: Experimental, Investigational or Unproven Services as shown in the revision history. 

EmblemHealth updated the Varicose Vein Treatment medical guidelines to add Medicaid coverage of endovenous mechanochemical ablation and subfascial endoscopic perforator vein surgery.

EmblemHealth updated the Gene Expression Profiling medical guidelines to add:

• Commercial and Medicare coverage of the Abbott Alinity^™ m STI Assay, Guardant Shield, and IsoPSA^®tests. 
• NavDx Medicare Coverage.
•  Immunoscore^® as investigational for all members.

EmblemHealth updated the Clinical Trials (Medicare) medical guidelines to add language clarifying that Category B devices that are integral to CMS-approved Category B Investigational Device Exemption (IDE) trials are covered.

EmblemHealth updated the Radiofrequency Ablation of Tumors medical guidelines to add nonmetastatic desmoid tumors to the investigational list.

ConnectiCare’s Medical Policy Updates

ConnectiCare updated the Experimental Investigational or Unproved Services Policy as shown in the revision history. 

ConnectiCare updated the Clinical Trials (Medicare) medical guidelines to add language clarifying that Category B devices that are integral to CMS-approved Category B Investigational Device Exemption (IDE) trials are covered.

ConnectiCare updated the Radiofrequency Ablation of Tumors medical guidelines to add nonmetastatic desmoid tumors to the investigational list.

Providers must notify Medicaid of any change of address, telephone number, or other pertinent information within 15 days of the change. For more information on this requirement and how to submit changes, see Reminder: Keep Your Directory Data Current. 

View the latest Medicaid Updates from the New York State Department of Health.

Our EmblemHealth Neighborhood Care locations and ConnectiCare Centers provide one-on-one customer support to help members understand their health plan, provide connection to community resources, and offer free health and wellness events to help the entire community learn healthy behaviors. Our virtual and on-demand events are available to you and all your patients. View locations and upcoming events for EmblemHealth Neighborhood Care and ConnectiCare Centers.

Let Us Know When Directory Information Changes

If a provider in your practice is leaving, please inform us as soon as possible. See how to submit data changes as required by our participation agreements for EmblemHealth and ConnectiCare.

If you participate with us under a delegated credentialing agreement, please have your administrator submit these changes.

Remember to review your CAQH application every 120 days and ensure you have authorized EmblemHealth as an eligible plan to access your CAQH information.

The EmblemHealth Provider Manual is a valuable online resource and an extension of your Provider Agreement. It applies to all EmblemHealth plans and includes details about your administrative responsibilities and contractual and regulatory obligations. You can also find information about best practices for interacting with our plans and how to help our members navigate their health care. A key resource is the Access, Availability, and After-Hours Coverage Standards, which set up the expected time frames for appointment availability, appointment wait times, and after hours coverage.

You can find the EmblemHealth Provider Manual in the top navigation menu of our provider website.