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Provider Portal Update
Billing Companies and Out-of-Network Providers Must Use the Portal To Receive Service
As part of our commitment to supporting an all-digital approach to managing health care, beginning Oct. 1, 2023, billing companies will, as a prerequisite to speaking with a Provider Customer Service representative, be required to first submit a message through our provider portal.
If a response is not received within two business days, only then may the billing companies call Customer Service. Billing companies will need to provide the Message ID from the portal to the customer service representative before the representative can continue with the call.
Furthermore, as of Oct. 1, out-of-network (OON) providers will only be able to message us through our portal and will only have access to the portal after submitting a claim and registering for a portal account. More information on this process will be published before Oct. 1. OON providers may use our IVR to check claim status, authorization and referral status, as well as member basic benefits and eligibility after entering the Member’s ID number and date of birth in the IVR. The only exception for speaking to a customer service representative is when OON providers need to request a medical or pharmacy authorization.
How will the portal save you time?
We encourage all our providers to use the portal for communicating with us. If you aren’t sure how, here’s where you can find more information. How will the portal save you time and effort? Documents submitted through the portal are all stored together. This means our staff can start working on issues without waiting for documents to be sent, scanned, and matched to the case. This significantly shortens the cycle time to resolution and shortens the time for you to get your answers.
How do you set up your billing company?
Make sure your portal administrator properly sets up your billing company staff with Billing Specialist portal accounts for your Tax ID(s), See the portal training material links below to find the correct guide to this process. If the billing company does not have someone to do this, you may need to assist them. To help with this, we have videos and guides on our websites with step-by-step instructions on how to get portal access and add, remove, and manage users.
New Live Agent Chat feature coming soon
In the coming months, we will also offer live agent chat on our provider portal. This feature will allow you to ask real-time questions with an agent, improving your own and your billing company’s experience with the portal.
More benefits of the portal
If you have not started using our portal, you should know it is an efficient and effective way to conduct your ConnectiCare and EmblemHealth business. Whether it is submitting preauthorizations online, checking member eligibility, making inquiries, submitting medical records, or looking up claims, our portal is a superior alternative to phone, fax, and regular mail.
More than 100 more surgical, sleep study, and durable medical equipment preauthorization request templates have been enhanced in our provider portals as of July 15, 2023, to allow users to:
- Share needed clinical information up front.
- Submit documents with the confidence that they are connected to the review request.
- Avoid time-consuming follow-up calls.
- Receive faster responses to requests when using the Submit Request button on the new MCG screen.
With just a few more clicks, you may be able to reduce unnecessary wait time to get a decision.
To get you our decisions faster, we are phasing in the delivery of our determination letters for preauthorization requests and initial and continued stay concurrent reviews (determination letters) through the provider portal. EmblemHealth’s New York commercial members (including members in self-funded, administrative services only (ASO) groups) have been prioritized so we can meet New York State’s mandate to deliver determination letters to members and providers electronically. We are striving to do the same for our EmblemHealth Medicaid, HARP, Child Health Plus, and Essential Plan members by the end of the year. This will be followed by delivering all determination letters through the provider portal for all EmblemHealth and ConnectiCare members in 2024. The training guides are being updated and will be available soon.
Where letters are in the portal
A new section, “UM Letters” has been added to the Preauthorization Details page for EmblemHealth’s New York commercial members.
Who can see the letters
Everyone who can see the preauthorization request will be able to see the letters including the requesting and servicing clinicians, the facility, and their authorized users.
Email notifications
The person making the preauthorization request, or their designee, will receive an email letting them know the determination letter has been posted. Going forward, electronic delivery of the notification will be the default option. This will allow us to expedite delivery of the determination letters days faster than by US Post.
We created a new MD Perspectives page to help you find all of our medical directors’ blogs. We also created a page for MD Perspectives Programs, Classes, and Resources that summarizes the recommendations we are making to help you care for our members.
MD Perspectives
Hello Colleagues,
Continuing with the topic of depression*, I want to take some time to discuss a specific condition: postpartum depression (PPD).
It is not uncommon for women to experience “baby blues” of possible sadness, crying, mood swings, anxiety, and/or irritability for a few days to weeks after pregnancy. For some women these symptoms can last longer, be more severe and interfere in their ability to care for themselves and/or their baby and meet the criteria for PPD. Untreated, PPD can be long-lasting and harmful. Thus, it is important to screen for, and assist in the treatment of, PPD. Learn more about PPD symptoms, screening, and resources for your patients.
*See Prescribing for Children and Adolescents With Depression.
Kelly
While we welcome your suggestions, we ask that you do not send protected health information (PHI) or patient-specific issues to this mailbox. This mailbox should not be used for complaints, grievances, appeals, or claims inquiries. The Claim Inquiry and Message Center features in the provider portals (EmblemHealth | ConnectiCare) should be used for those issues.
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