Office Visit

EmblemHealth and ConnectiCare are continually developing our portfolio of quality- focused materials to help you meet your quality goals and improve health outcomes for our shared members. Providers may find these helpful documents on our EmblemHealth Quality Improvement web page and ConnectiCare Quality Improvement web page.

Some new or updated additions to our quality web pages include:

• The 2023 Quality Measure Resource Guide —
  • The Quality Measure Resource Guide provides a brief overview of national and state quality measures that are sourced from National Committee for Quality Assurance (NCQA) and Centers for Medicare & Medicaid Services (CMS). The measures evaluate various domains of preventive, acute, and chronic care.
  • These updates align with the measures providers will be receiving in their 2023 gap in care reports.


• CAHPS Tips for Improving Member Satisfaction — Our network providers, their physical offices, staff, and office policies play a fundamental role in influencing patient perceptions surrounding their health care experiences. Every spring, the Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) survey is sent to a random sample of Medicare, commercial, and Health Insurance Marketplace^® (exchange) members to capture those patient experiences. Medicaid members receive the survey in the fall. Explore our materials that provide best practices on how to improve your CAHPS scores.


• Supplemental Data Training PowerPoints — We encourage providers to let us view your patients’ medical records and to supply supplemental data from your electronic medical record (EMR) systems to ensure we capture all the pertinent information regarding your patients’ care. These PowerPoints provide the when, where, and how.

Contact your provider network relationship manager for more information. You may also email the Quality team at quality_providerengagement@emblemhealth.com.

In the past several weeks, EmblemHealth and ConnectiCare began simplifying the delivery of quality care by eliminating the need for preauthorization on scores of CPT codes and changed the review requirements for approximately 400 inpatient elective/emergent diagnosis codes. These changes are part of a multiyear effort that, along with provider portal updates that streamline requests, is expected to save our providers time and effort. Large health systems in New York may save approximately 7,350 hours of staff time per year, while Connecticut health systems could save 3,980 hours per year.

New portal tools to save time

Key to the provider administrative savings is new functionality on the portal that gives clinicians an answer on their preauthorization requests and clinical reviews significantly faster than if they submitted requests by phone or fax. This integration through health care software company MCG Health gives our providers an efficient and effective alternative to archaic fax and phone processes. Today in the provider portal, you can attach medical records and other documents in support of preauthorization requests, concurrent reviews, and emergent inpatient admission and newborn notifications.

For our network facilities, they may only need to notify us that a member is in a bed so we can help their staff and the member prepare for discharge and post-acute care. These changes can also allow hospitals to accelerate the transfer of a patient needing home care or admission to a skilled nursing facility—especially during weekends. By speeding up the authorization process through our portal, hospital nursing staff will spend less time waiting for us and can focus on connecting our members to the post-acute care they need.

Free up time and staff for patient care

The real benefits come for providers who choose to give up fax and phone for our provider portal. While reviewing our regularly updated preauthorization lists online (EmblemHealth / ConnectiCare Commercial / ConnectiCare Medicare) is the fastest way to look up if a procedure requires a preauthorization, the provider portal is the fastest way to submit a request for a decision. If a preauthorization request is needed, providers can answer some questions and submit clinical information on the portal to get the review and approval process moving, saving significant time and effort. The portal will ask the same questions, and allow attaching the same clinical documents, that we would ask for if a provider faxed their initial request—but WITHOUT the delay that comes with having to follow up by phone.

Need more information?
We encourage you to review our Frequently Asked Questions (EmblemHealth | ConnectiCare) which further describe the rolling updates to both process and provider portal that we believe will deliver meaningful change to our network.

If providers need help navigating our provider portals, they can see our videos, quick guides, and portal Frequently Asked Questions here:

EmblemHealth Videos and User Guides             EmblemHealth FAQs

ConnectiCare Videos and User Guides               ConnectiCare FAQs

If providers still have questions or need additional support, they may contact Provider Customer Service:

EmblemHealth: 866-447-9717

ConnectiCare: Commercial: 860-674-5850, Medicare: 877-224-8230

It is important to note that this change to preauthorizations and clinical reviews only applies to procedures and diagnoses reviewed by EmblemHealth and ConnectiCare. We are continuing to talk with our delegated vendors about their preauthorization processes and whether similar changes can be made. We will share more information as it becomes available.

With the end of the Public Health Emergency (PHE) for COVID-19, many policies and processes are returning to a prepandemic level. See how we are advising our members on these changes (EmblemHealth | ConnectiCare).