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Provider Toolkit

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Provider Resources

A dedicated page of useful materials you can give your EmblemHealth patients to help manage their care and keep their costs down.

 

Recently added

 

Welcome to EmblemHealth

Here is some information to help you get to know us and help you best serve our members, your patients.

  • 2021 Summary of Companies, Lines of Business, Networks and Benefits Plans

  • 2021 Benefit Plans That Do Not Require A Referral

  • Medicaid/HARP/CHP Resource Guide

    Anticipated 2021 Changes, 2020 News Recap, & Medicaid Compliance Requirements

  • 2021 Medicare Advantage Guide

  • 2021 Caring for Bridge Program Members: Reference Guide

  • EmblemHealth Guide for Electronic Claims Submissions

  • 2020 Summary of Companies, Networks & Benefit Plans

  • 2020 Benefit Plans that Do Not Require a Referral

  • EmblemHealth Quick Reference Card - Using our Secure Provider Portal

  • Access and Availability Requirements

  • 2020 EmblemHealth Contact Information – Frequently used numbers and websites

  • Network Laboratories – Quest Diagnostics is our preferred clinical laboratory

  • Frequently Asked Questions about Electronic Funds Transfer and Electronic Remittance Advice

  • Improving the Patient Experience

  • ConnectiCare Members May Use Providers in the EmblemHealth Prime Network

  • 2020 Medicare Advantage Guide

  • “How Do I…” Provider FAQs

  • ConnectiCare Website Information
 

Your Plan Members

 

Access to Care and Delivery System

 

Medical Record Guidelines

 

Claims

Visit Claims Corner for the latest information on our claims policies.

  • Health Home Billing Guide - Under Revision

  • EPO/PPO Corrected Professional Paper Claim Form

  • National Provider Identifier (NPI) Reporting Sheet

  • Electronic Funds Transfer and Remittance Advice (EFT-ERA)

  • National Plan and Provider Enumeration System (NPPES)

  • Unlisted Procedure Codes Form

  • Assignment of Benefits Form

  • National Government Services Policy Education Topics: Modifier 25
 

Care Management

Visit Clinical Corner for practice guidance resources.

  • Advise Your Patients to Visit Our Network Urgent Care Centers for Non-emergent Medical Care

  • Supporting Your Patients with the Healthy Futures Program

  • Medical Policies

  • Medical Technologies Database

  • Occupational Health Clinic Joins EmblemHealth

  • NYCDOHMH Primary Care Information Project (PCIP): Public Health Action Kits for Providers

  • Information for Providers - Hepatitis C
 

Domestic Violence Resources

 

Health Promotion

 

Behavioral Health Services

  • Mental Health and Substance Abuse

    EmblemHealth strongly encourages care of the whole person. Please see screening tools and other valuable resources for the identification and treatment of mental health and substance abuse issues. 
 

Pharmacy Services

 

EmblemHealth Spine Surgery and Pain Management Therapies Program

 

Radiation Therapy, Cardiology Imaging and Radiology Programs

 

Physical and Occupational Therapy Program

 

Credentialing

See the Join Our Networks page and the Credentialing chapter of the EmblemHealth Provider Manual for our application instructions and credentialing and recredentialing policies, procedures and forms. 

 

Regulatory Mandatory Reporting

 

Required Provisions To Network Provider Agreements

 

Tips and Tools

 

Additional Resources

  • Alcohol Abuse Screening Tool and Clinical Guidelines for Non-Mental Health Providers

  • Behavioral Health Screening Toolkit for Primary Care Physicians

  • Depression Screening Tool and Clinical Guidelines for Non-Mental Health Providers

  • EmblemHealth HDHP Programs ConsumerDirect EPO and ConsumerDirect PPO

  • Home Incentive Program Practitioner Quick Reference

  • In Home Health Screenings by MedXM

  • Legislation Enacted To Increase HIV Testing in New York State

  • Office of Health Insurance Programs Principles for Medically Fragile Children

  • Provider Quality Measure Resource Guide
 

Archive

Our Call Center is currently experiencing extremely high volume and longer wait times. For questions related to COVID-19, visit our COVID-19 FAQs

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© 2020 EmblemHealth. All Rights Reserved.

Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.