Provider Help and Support | EmblemHealth

Our new Provider Portal is designed to be simple and intuitive. Should you need help, we have posted a series of videos and user guides to help you step by step through each transaction. 
 

We also created a frequently asked questions webpage to address the most common issues our Provider Customer Service team has been receiving. 
 

Here are some key things you need to know:

This portal is organized by Tax ID numbers. For each Tax ID, a user is assigned a role called User Type, which defines what information and transactions they can see.  By default, new users have access to conduct business for all providers who share the same Tax ID. Users who were migrated from our old portal were given access to the same set of providers they had access to in the old portal. Those users have the ability to consolidate their old accounts under one username and password (also referred to as PIN). 
 

Administrator/Office Manager Role

Each provider/practice/facility needs to select someone to be their Administrator/Office Manager. That person is responsible for setting up new users, determining what transactions they can do (User Type or Role), and who they may conduct business for (if not everyone affiliated with the Tax ID). The person who first activates the master account is automatically assigned the Administrator/Office Manager role. In support of HIPAA compliance, we are looking to our providers to manage their own users. Our Provider Customer Service team does not have the ability to set up individual users or change their portal access. If the person who activated the account will not be the ongoing Administrator/Office manager moving forward, the current Office Manager can reassign the role to the new Office Manager.
 

New Accounts

When a new provider joins our network, we will contact the practice/organization and share a Registration Code(s) with the Administrator/Office Manager to set up the account and add users. If the practice/organization uses more than one Tax ID, each Tax ID will need to be registered. All registrations can be done using the same username, password/PIN, and email address so portal access for all Tax IDs is consolidated.
 

Identifying the Referring or Submitting Provider

For each transaction, the user must identify the provider they are submitting the transaction on behalf of. This is true even if the user is the provider or the user only has access to conduct business for one provider. This means searching for a Referring Provider for referrals, a Requesting Provider for preauthorizations, etc. You can search by name or by NPI. Company-issued provider IDs are no longer needed.

You can watch the video and refer to the materials in this “Do I Need a Referral?” – A Quick Guide.
 

Tip: In the Provider Portal, you must select both the Referring and Servicing providers.

You can find EmblemHealth medical policies in Clinical Corner. These medical policies reflect some of the information we consider when determining the medical necessity of certain services or supplies.

You can:
  • submit electronic claims to EmblemHealth using the Payor IDs listed in the Claims Contacts chart in the Directory chapter of the provider manual.
  • submit paper claims (CMS-1500 forms) to the addresses listed in the Claims Contacts chart, unless otherwise indicated on the member’s ID card.

For more information please click here.

Religio-Cultural Competency

Properly addressing religion is a key element of providing patient-centered care and improving health outcomes and patient and family satisfaction. That’s why we partnered with the Tanenbaum Center for Interreligious Understanding, a secular nonprofit organization dedicated to overcoming religious bias and intolerance, to create resources that help medical practitioners understand how religious beliefs and practices intersect with medical science. For more information, please see the Cultural Competency Continuing Education and Resources section of our Learning Online page.

Language Line: Interpreter Service

Free multi-language interpreter service is available to assist providers and their patients. Services are available in over 200 languages, including English, Spanish, Chinese Mandarin, Chinese Cantonese, Tagalog, French, Vietnamese, German, Korean, Russian, Arabic, Italian, Portuguese, French Creole, Polish, Hindi and Japanese. To access an interpreter, providers may call 1-866-447-9717 and a Provider Customer Care Advocate will assist you.

EmblemHealth has dedicated a web page of useful member materials on our Live Well site so your EmblemHealth patients can manage their care and keep their costs down.    

Providers should verify member eligibility as outlined in the chart below.

Confirm Member Eligibility

Provider Network

Instructions
(Choose one of the bulleted options)
Have your TIN ready before calling the IVR system

Select Care Network

Prime Network

Bridge Program for plans underwritten or administered by EmblemHealth Insurance Company

Enhanced Care Prime Network

VIP Prime Network

Bold Network

Reserve Network

Millennium Network

  • Check eligibility at emblemhealth.com
    • PCPs may also check their Panel Reports
  • Speak to a representative or call the IVR phone system at 866-447-9717
  • Providers with eMedNY access may use ePACES to check the enrollment of their Medicaid members and Medicare/Medicaid dual eligible members.

Bridge Program for plans underwritten by EmblemHealth Plan, Inc.

CBP, National & Tristate Networks

Network Access Network

  • Check eligibility at emblemhealth.com
  • Speak to a representative or call the IVR phone system: 
    NYC: 212-501-4444 
    Outside NYC: 800-624-2414
Medicare Choice PPO Network
  • Check eligibility at emblemhealth.com
  • Speak to a representative or call the IVR phone system at 866-557-7300