August 2023
Provider Portal:
Addressing Denied Claims

TABLE OF CONTENTS
Use the Provider Portal To Address Denied Claims
Finding Claims
Finding Sent Messages, Responses, and Next Steps
Learn About Other Portal Features
Still Don’t Have a Portal Account?
Use the Provider Portal To Address Denied Claims
We know denied claims are not what you want to see. But if you get one and have a question about it, or believe it was denied in error or paid at the wrong rate, using the provider portal is a much better path forward than using mail, phone, or fax.
Need to address one of the following that are unrelated to a medical necessity determination?
- Claim inquiry.
- Grievance.
- Denial message request for records or supporting documents.
To start a new conversation about one of these issues, use the Claims Search feature rather than the Message Center.
Here are the steps to take to start a new conversation:
- Look up the claim. Note: the user’s portal account must be linked to the Tax ID used on the claim.
- Use the Ask a Question button.
- Select Category and Subcategory.
- Enter message.
- Attach requested and/or supporting documents. (Up to five.)
- Press Send.
- Make note of the Message ID and use the Message Center going forward.
Here are the steps to take to add more documents to the conversation:
- Click the down arrow next to your name at the top of the screen and select My Messages from the menu.
- Use the Message ID to find and open the message you just submitted.
- Use the Follow-up button to create a linked message. Attach and submit up to five more documents. Continue sending follow-up messages until all documents have been uploaded to the same Message ID.
Continue using the same Message ID to communicate with us until the issue is resolved. Starting a new conversation will just slow things down.
EmblemHealth: Try it Now
Connecticare: Try it Now
Finding Claims
For step-by-step instructions on finding Claims, see these guides for an overview of how to View Status, Submit Documents & Inquiries, and Create Custom Reports.
- EmblemHealth: View Guide
- ConnectiCare: View Guide
Finding Sent Messages, Responses, and Next Steps
For step-by-step instructions on finding the messages you sent and the responses to them in the Message Center, see these guides and videos:
Search and View Messages – See steps for searching for and viewing messages.
- EmblemHealth: View Guide | View Video
- ConnectiCare: View Guide | View Video
If you receive a response to a claim inquiry and would then like to submit a formal grievance, reply to the response. State that it is a grievance and explain why you believe the claim should be paid. Attach new supporting documentation you would like to be considered.
Learn About Other Portal Features
Whether you are a first-time user who needs to set up an account or a regular user who wants to learn more, we have videos, step-by-step guides, and frequently asked questions (FAQs) to help you:
If you still cannot find what you need, use the Message Center to send us your questions.
We appreciate your commitment to our members’ health. Keep an eye out for more email updates on our provider portal.
Still Don’t Have a Portal Account?
If you need to use the provider portal, your organization’s portal Administrator/Office Manager can set you up. In support of HIPAA compliance, we look to our providers to manage their own users.
If your organization needs to set up a master account for a new Tax ID, contact our Provider Customer Service team at:
- EmblemHealth: 866-447-9717
- ConnectiCare: Commercial: 860-674-5850 | Medicare: 877-224-8230
We hope you take advantage of our provider portal and all of the ways it can save you time.
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