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We want to make sure your patients maintain their coverage and continue to receive the care you provide. Remind your patients to have documentation ready prior to renewing their health coverage for EmblemHealth Enhanced Care (Medicaid), Enhanced Care Plus (HARP), Child Health Plus (CHPlus), and Essential Plan (EP).

The lack of required and/or accurate documentation is a significant reason for termination of their benefits.

For a list of information needed for renewal, refer your patients to the Renewal Checklist. For in-person help preparing documentation, patients can visit an EmblemHealth Neighborhood Care location where they can meet with our team.

In accordance with updated guidance from the New York State Department of Health, all contracted licensed home care services agencies and consumer directed personal assistance program fiscal intermediaries must complete and submit the Department of Labor form LS300, “Annual Compliance Statement of Wage Parity, Hours and Expenses,” for calendar-year 2022 (and 2021, if not already submitted last year) to EmblemHealth via email at wageparity@emblemhealth.com.

The due date for independently audited financial statements verifying wage parity expenses for calendar years 2021 and 2022 will be announced later.

Effective June 14, 2023, the duration of postpartum health coverage for EmblemHealth Medicaid and CHPlus members was expanded from 60 days to a full year following pregnancy, regardless of immigration status or how the pregnancy ended. The postpartum period is critical for recovering from childbirth, addressing complications of delivery, ensuring mental health, managing infant care, and transitioning from obstetric to primary care. For more information, visit the State-Sponsored Programs provider hub.

As a reminder, contracted fiscal intermediaries (FIs) must submit the signed “Consumer Directed Personal Assistance Program Agreement Between the Consumer/Designated Representative and the Health Plan” (Consumer Agreement) to EmblemHealth upon the authorization of consumer directed personal assistance services for an EmblemHealth Medicaid member. This agreement should be sent to EmblemHealth’s long-term support services by email at longtermsupportservices@emblemhealth.com or fax at 212-510-5248.

For more information, visit the State-Sponsored Programs provider hub.

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.

EmblemHealth Preauthorization List: See Notable Changes for updates.

See revision histories for the updates to the following lists:

• GHI PPO City of New York Preauthorization List.
• ConnectiCare Commercial Preauthorization List.
• ConnectiCare Medicare Preauthorization List.
• EmblemHealth/ConnectiCare Home Infusion Therapy Drug Preauthorization List.
• The Pharmacy Medical Preauthorization Lists for EmblemHealth and ConnectiCare.

ConnectiCare’s Formula and Enteral Nutrition medical policy along with the following medical policies for both EmblemHealth and ConnectiCare have been retired:

• gammaCore Sapphire CV for Coronavirus Disease 2019.
• Lymphedema Treatment.
• Noninvasive Prenatal Testing for Fetal Aneuploidy.
• Periurethral Bulking Agents for Urinary Incontinence.

If a provider in your practice is leaving, please inform us as soon as possible. To report other changes, sign in to your Provider/Practice Profile for EmblemHealth or ConnectiCare. If you participate with us under a delegated credentialing agreement, please have your administrator submit these changes. See more on how to submit changes for EmblemHealth and ConnectiCare.

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. You can find the EmblemHealth Provider Manual on the top right side of our website.

Our EmblemHealth Neighborhood Care 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.