Learn how the Bridge Program applies to NYCE PPO, Large Group, and ASO plan members in 2026.
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May 14, 2026
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Our vendor, Datafied, is contacting health care providers who are part of the RADV audit sample. Datafied is asking providers to submit the complete medical record for specific patients for dates of service between Jan. 1, 2019, and Dec. 31, 2019. Providers who have not yet supplied the requested records to Datafied will be contacted by a representative to secure the charts.
Please note that member authorization is not required to release the medical records based on the business associate agreement between EmblemHealth and Datafied.
When you receive a request from Datafied, we ask that you respond promptly and submit the required documentation using one of the secure delivery methods detailed in the communication materials.
Providers who work with a vendor to manage medical records are encouraged to notify their service suppliers now so that responses to Datafied’s requests can be issued timely.
Centers for Medicare & Medicaid Services (CMS) recently issued notice to EmblemHealth that five additional contract-level RADV audits will be conducted between May 2026 and August 2027.
Each audit may require you to submit additional medical records as described above. EmblemHealth will continue to alert you through this type of communication when the next audit is underway.
A cancer diagnosis can quickly overwhelm patients. Even after a thorough office visit, many patients leave with unanswered questions, unmanaged symptoms, or financial, logistical, or emotional barriers that can disrupt care. That’s where additional support matters and why EmblemHealth partners with Thyme Care to provide cancer care management for members undergoing testing or treatment.
This program extends and reinforces your practice’s care between visits, helping patients stay informed, supported, and on track. Through Thyme Care, your patients can receive care from oncology-trained nurses and licensed social workers who:
- Reinforce your care plan and answer questions between visits.
- Monitor symptoms and escalate concerns early.
- Coordinate care and address barriers that impact adherence.
How Thyme Care keeps you informed
Thyme Care functions as an extension of your team, using its care platform and electronic health records integrations to keep you informed without the administrative burden.
You can expect:
- Timely updates on patient status, symptoms, and care coordination.
- Insights from proactive outreach and patient-reported outcomes.
- Escalation of urgent issues and alignment with your care plan.
When to contact Thyme Care and how to refer a patient
- Online: thymecare.com/referapatient
- Email: careteam@thymecare.health
- Phone: 201-526-8484
Note: The referral site includes step-by-step instructions and eligibility criteria. In most cases, a simple referral initiates outreach from the Thyme Care team.
For a deeper look at how Thyme Care supports primary care providers, visit thymecare.com/primarycaregroups.
Caring for your patients who have behavioral health issues is important to their overall health. To help you support your patients’ mental health, we updated the behavioral health section of our provider website, including:
- Behavioral health clinical practice guidelines.
- Behavioral health and substance use.
- Provider manual chapter 26 on behavioral health services.
Collaboration among medical and behavioral health providers is key to better patient health outcomes. Visit our behavioral health page to view these resources.
As part of proactive behavioral health care, remember to include routine depression screenings for your patients, which support early identification to help your patients receive timely, appropriate care. This includes screenings for adolescents age 12 through 17 and adults age 18 and older.
New Provider Bonus
Providers treating our state-sponsored program members can also earn EmblemHealth’s new Depression Screening Bonus, which was recently introduced as part of the 2026 Quality Incentive Program. To help qualifying providers earn this bonus, see our Tip Sheet: Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) which includes guidelines, best practices, and follow-up care options for patients who receive a positive depression screening.
Effectiveness of Care FMC HEDIS Measure
Behavioral health visits, substance use disorder visits, and/or a community mental health center visits are all part of follow-up care for patients with high-risk chronic conditions who recently had an emergency department (ED) visit. These are included in the Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (FMC) HEDIS Measure.
This Effectiveness of Care FMC HEDIS Measure looks at the percentage of patients 18 years or older who have multiple high-risk chronic conditions and have had a follow-up service within seven days of an ED visit. This measure helps ensure patients with high-risk chronic conditions, who often receive care from multiple providers, are monitored and followed to improve long-term health. This also helps decrease adverse outcomes like frequent ED visits, hospitalizations, nursing home admissions, medication errors, and even death. Follow-up services include:
- Behavioral health visit.
- Substance use disorder visit.
- Community mental health visit.
- Outpatient visit.
- Telephonic visit.
- Virtual care visit.
- E-visit or virtual check-in.
- Telehealth visit.
- Transitional care management visit.
- Care management visit.
- Complex care management services.
- Intensive outpatient or partial hospitalization.
- Rest home/domiciliary visit.
- Partial hospitalization visit.
- Electroconvulsive therapy.
HEDIS Measure follow-up tips
- Contact the patient when you receive the ED notification and schedule a follow-up visit within seven days of discharge.
- You can schedule a visit on the date of the discharge.
- Keep appointments open so patients with an ED visit can be seen within seven-days.
- Review the discharge summary with the patient to confirm they understand their instructions.
- Complete a medication reconciliation with the patient and/or their caregiver.
- Ensure new prescriptions have been filled at their pharmacy.
- Instruct patients to call with concerns, symptoms, or changes in their condition.
- Explain the importance of regular follow-up appointments.
- Visits can be completed by office staff including a medical assistant, licensed practical nurse (LPN), registered nurse (RN), and social worker.
June 27 is National HIV Testing Day. We encourage you to talk to your patients about being tested for human immunodeficiency virus (HIV). This year’s theme is Level up your self-love: check your status.
The Centers for Disease Control and Prevention (CDC) recommends that patients between the ages of 13 and 64 receive an HIV test during their routine physical as HIV testing is a pathway to engage people in their care. When patients are aware of their HIV status, it can help them make choices to stay healthy, regardless of their test results.
To support this effort, we offer a Care Management program to help EmblemHealth members living with HIV/AIDS. This is a free service that helps members find community resources and navigate the health care system. You can refer your members to our HIV/AIDS Resources page for more information.
We ask our New York providers to consider registering for inclusion in the New York State Department of Health PrEP Prescribers directory.
Here are other resources you can use and share with our members:
- NYSDOH Online Resources for Education, Information, and Services: guidance on HIV perinatal prevention, primary and specialty HIV care, and other related HIV treatment topics.
- CDC HIV PrEP Resources: an online library of HIV resources, including HIV PrEP, which is a preexposure prophylaxis (PrEP). It may protect patients against HIV even if their partner has HIV.
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