Learn how the Bridge Program applies to NYCE PPO, Large Group, and ASO plan members in 2026.
Search
Popular Tasks
Office Visit
Your source for important provider news and updates.
October 15, 2026
Featured Stories
As we announced on Sept. 30 in News and Updates, the Office of Health Insurance Programs (OHIP) has a new requirement for all Medicaid Managed Care plans as of Oct. 1, 2026. Home Care Registry IDs must be included on all Home Health Aide, Personal Care, and Consumer Directed Personal Assistance Services (CDPAS) encounters submitted for Medicaid and HARP members. Direct Care Worker information must be populated within the applicable rendering provider loops outlined below.
Direct Care Workers who do not have a National Provider Identifier (NPI) will be identified using Home Care Registry IDs for all Home Health Aide and Personal Care encounters and using Statewide Fiscal Intermediary (SFI) Personal Assistant IDs for all CDPAS encounters for dates of service starting Oct. 1, 2026.
Providers must submit Home Care Registry ID or SFI Personal Assistant ID as the rendering provider on all Home Health Aide, CDPAS, and Personal Care encounters as follows:
Institutional Encounters (837I)
| Description | Institutional Encounters (837I) | Professional Encounters (837P) |
| Direct Care Worker ID (Home Care Registry ID or SFI Personal Assistant ID) | 2310A REF02 2420C REF02 (conditional) REF01 = G2 (Required if national provider identifier [NPI] is not available) | 2310B REF02 2420A REF02 (conditional) REF01 = G2 (Required if NPI is not available) |
| Example: | REF*G2*SFI ID / Home Care ID~ | REF*G2*SFI ID / Home Care ID~ |
For encounters where the same Direct Care Worker provides all lines, the 2310A/2310B loops can be used. If the encounter has services provided by multiple Direct Care Workers, the provider information should be submitted on the 2420C/2420A loops.
Claims Submission and Electronic Data Interchange (EDI) Clearinghouse Guidance
Claims for Home Health Care provided by Licensed Home Care Services Agencies (LHCSAs), Certified Home Health Agencies (CHHAs) and Consumer Directed Personal Assistance Services (CDPAS) provided by the Statewide Fiscal Intermediary (SFI) must have the Home Care Registry ID or Statewide Fiscal Intermediary Personal Assistant ID reported here: 837P: Loop 2420A REF02 / 837I: 2420C REF02.
Direct Care Workers are not required to have an NPI. Therefore, EDI Clearinghouses must ensure they accept the Home Care Registry ID or SFI ID for Licensed Home Care Services Agencies, Certified Home Health Agencies, and the Statewide Fiscal Intermediary to submit these HIPAA compliant segments. See the Homecare Worker ID EDI Letter for an example.
Full Description [Web/Landing Page Copy]: To help make it easier for you to keep track of your claims history, we have extended the lookback period for claims data from two to three years. You will be able to find your claims history within the range of three years from the date you are searching. The way that you search for claims data in our provider portal is still the same.
For example: If you enter a claim and the date of service falls within the three-year look back period from the day you are searching in the portal, up to three-years ago, you will be able to find it. If it is outside of the three-year time frame, you will not be able to find it.
Note: When you search for a claim, you will be presented with the option to enter the service date. Users will be able to search for claims submitted within the last three years. Search results, however, will only be displayed showing 90 days of information at a time.
While you review your provider portal users, consider who else in your practice should be set up with a provider portal account. This is the perfect time to add them and help streamline your office operations. Let other providers and staff in your organization know about this update so they can take advantage of this new provider portal feature.
November is Diabetes Awareness Month and World Diabetes Day is Nov. 14. This is a great opportunity to educate your patients on diabetes prevention and control and share helpful resources.
According to a 2026 National Diabetes Statistics report from the U.S. Centers for Disease Control and Prevention, an estimated 40.1 million people in the U.S. have diagnosed or undiagnosed diabetes.
GSD HEDIS® measure requirements
Proper diabetes management is essential to help your patients control their blood glucose, reduce risks for complications, and prolong life. It is also key to meeting the Glycemic Status Assessment for Patients with Diabetes (GSD) HEDIS measure.
- Who is included in this measure: Patients 18 to 75 years of age with Type 1 or Type 2 diabetes.
- Actions needed for compliance: Document an appropriate hemoglobin HbA1c (A1C) level or glucose management indicator (GMI) for a diabetic patient. A lower A1C level indicates better performance for this indicator.
- Controlled A1C: < 8%
- Uncontrolled A1C: > 9%
We urge providers to take action with members who fall between 8 and 9% so they do not progress to uncontrolled A1C.
We encourage providers to intervene early with members whose A1C/GMI levels are between 8% and 9% to help prevent progression to uncontrolled diabetes.
Documentation in the member’s medical record must include a note indicating the date when the HbA1C test was performed and the result. GMI values must include documentation of the continuous glucose monitoring (CGM) data timeframe used to find the value. The terminal date in the range should be used to assign the assessment date.
If you care for members who may be at high risk for diabetes or already have it, you can share our member diabetes guide that has information on detection, control, and treatment. This can help explain what diabetes is, the symptoms, and related complications so patients have a better understanding of how their diabetes diagnosis may affect them and what to do to get it under control.
For encouragement, share our success story about EmblemHealth member Peter Agusto. Mr. Agusto attended the Community Diabetes Wellness Program at EmblemHealth Neighborhood Care and came away with life-changing results. Neighborhood Care offers a Diabetes Wellness program for members concerned about diabetes or prediabetes, providing screenings and classes designed to prevent or manage this condition.
Lung cancer is the leading cause of cancer-related deaths in America. Screening is used to detect lung cancer early when it is more likely to be curable. According to the American Lung Association, if lung cancer is caught before it spreads, the likelihood of surviving five years or more improves by 65%.
National Lung Cancer Screening Day is Nov. 14, 2026. The American Cancer Society and U.S. Preventive Services Task Force recommend yearly lung cancer screening with a low-dose CT scan for current and former heavy smokers ages 50 and older.
JP72810