May 2026

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.

Quality Corner

Managing osteoporosis is an important part of delivering necessary care to our older members. Be sure to assess women 67 to 85 years of age who suffered a fracture and recommend a bone mineral density (BMD) test or a prescription for a drug to treat osteoporosis in the six months after the fracture. For patients who are unable or unwilling to have a BMD test, you may want to place a reminder in the patient’s chart for a BMD test soon or prescribe osteoporosis medications as appropriate.

There are several exclusions:

Patients who had a BMD test during the 730 days (24 months) prior to the fracture episode.
Patients who had a claim/encounter for osteoporosis therapy during the 365 days (12 months) prior to the episode.
Patients who received a dispensed prescription or had an active prescription to treat osteoporosis during the 12 months prior to the episode.

Remember, you can partner with your EmblemHealth team to offer in-home BMD screening assessments for your patients. If you do not already have a contact, please email us at quality_providerengagement@emblemhealth.com. Use telehealth visits to review, document, and prescribe medication, as appropriate. Educate patients on safety and fall prevention.

Osteoporosis management in women is also a key quality measure under the Healthcare Effectiveness Data and Information Set (HEDIS^®). Keep reading for some of our HEDIS tips below.

HEDIS Tips for Osteoporosis Management in Women Who had a Fracture (OMW):

Schedule an office visit as soon as possible after the fracture occurs.
Obtain a copy of the x-ray to confirm the fracture.
Ensure that there is proper documentation in the patient’s medical records.
When submitting medical records, include the bone density report dated with results along with a medication list including osteoporosis medication and the date it was started.
Documentation the osteoporotic medication isn’t tolerated is not an exclusion for this measure.

Note: Fractures of the fingers, face, toes, and skull are not included in this HEDIS measure.

Screening types for osteoporosis

Bone mineral density (BMD).
Dual x-ray absorptiometry (DEXA/DXA).
Ultrasound densitometry.
Quantitative computed tomography.

Summer is right around the corner. While children are home from school during the summer break, it’s a good time for child wellness visits including dental checkups.

When seeing your pediatric patients, talk to their families about the link between oral and overall health, and encourage routine dental visits beginning as early as age one, or at the first tooth eruption.

Remind your patients that no referral is required to see a dental provider.

For additional guidance, learn about Bright Futures, a national health promotion and prevention initiative, led by the American Academy of Pediatrics and supported, in part, by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau.

You can conduct or schedule well-care visits when patients come to your office for illnesses or other events. The claim modifier for separate and distinct services should be added. Telehealth cannot be used for the Healthcare Effectiveness Data and Information Set (HEDIS^®) Well-Child visit measure but may be submitted for other medical record reviews. Be sure to submit the appropriate CPT code with GT modifier.

HEDIS Tips and Information for Well-Child Visits

Child and adolescent well-care visits (WCV) are for members 3 to 21 years of age who have had at least one comprehensive WCV with a primary care provider (PCP) or OB/GYN practitioner during 2026.

Visits may include weight assessment and counseling for nutrition and physical activity for children and adolescents (WCC), for members 3 to 17 years of age who had an outpatient visit with a PCP or OB/GYN, involving a body mass index (BMI) percentile assessment, and nutrition and physical activity counseling.

BMI percentile documentation

Documentation of height, weight, and BMI percentile in medical records.
Plotting BMI percentile on an age growth chart is acceptable.
BMI documented as a value of 80^th percentile or 80%.
Notation of BMI value only is not acceptable. For example, BMI 16.
BMI ranges are not acceptable between 50^th– 75^thpercentile.

Acceptable nutrition and physical counseling documentation

Start with discussing current nutrition and physical behaviors like eating habits and dieting behaviors, exercise routine, or participation in sports activities, or do an exam for sports participation.
Consider these assessment examples: “Patient has an adequate or well-balanced diet.” “Diet regular.” “Lack of physical activity” (if not related to an acute or chronic condition). “Patient gets an adequate amount of exercise.”
Make a checklist indicating if nutrition or physical activity was addressed.
Offer counseling or referral for nutrition or physical activity.
Provide educational materials for nutrition and physical activity during a face-to-face visit.
Give anticipatory guidance for nutrition or specific to physical activity.
Give weight or obesity counseling (eating disorders). Services rendered for obesity or eating disorders meet criteria for both nutrition and physical activity counseling.
A referral to Women, Infants Children program (WIC) or a member enrolled in WIC counts for nutritional counseling.

Unacceptable nutrition and physical counseling documentation

A physical exam finding or observation alone, like documenting the patient is well-nourished, or developmental milestones alone (For example, “Do they throw a ball?”).
Discussion without mention of nutrition or physical activity (“appetite,” “limits TV/computer time,” “cleared for gym class,” “healthy lifestyle habits”).
Visits specific to the assessment or treatment to an acute or chronic condition. For example: The member presents with diarrhea and receives instructions for bananas, rice, applesauce, and toast (BRAT) diet; The member presents with knee pain and can run without limping; The member has exercise-induced asthma.

Screening	Question	Screening Code	Answer	Finding Code
Housing	What is your living situation today?	71802-3	I have a steady place to live.	LA31993-1
			I have a place to live today, but I am worried about losing it in the future.	LA31994-9
			I do not have a steady place to live. (I am temporarily staying with others, in a hotel, in a shelter, living outside on the street, on a beach, in a car, abandoned building, bus or train station, or in a park.)	LA31995-6
Food	Within the past 12 months have you been worried that your food would run out before you got money to buy more?	88122-7	Often true	LA28397-0
			Sometimes true	LA6729-3
			Never true	LA28398-8
Transportation	In the past 12 months, has lack of reliable transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?	93030-5	Yes	LA33-6
			No	LA32-8

Search

Popular Tasks

The Bridge Program

Office Visit

Popular Tasks

The Bridge Program

Office Visit

Featured Stories

RADV Audit for 2020 Underway

Support for Your Patients With Cancer

Updated Behavioral Health Information

Support HIV Testing Day June 27

Claims Corner

Reimbursement Policies

Clinical Corner

Updated Preauthorization Lists

Quality Corner

Osteoporosis and Treating Women After a Fracture

Pediatric Dental Check-ups and Well-Child Visits

Pharmacy

Pharmacy Medical Policies

Medical Policies

Medical Policy Updates

NY Medicaid, HARP, and Child Health Plus Updates

See Recent State-Sponsored Program News

New York State Medicaid Update

Change of Address and Contact Notification

Medicare Updates

Medicare Outpatient Observation Notice (MOON)

Training Opportunities

NYCE PPO Self-Directed Webinar

Provider Portal Videos and Guides

Valuable Medicare and Medicaid Training Available

In Every Issue

EmblemHealth Neighborhood Care

Keep Your Directory and Other Information Current

Consult EmblemHealth’s Online Provider Manual for Important Information

Keep Your Directory and Other Information Current 

Consult EmblemHealth’s Online Provider Manual for Important Information 