Provider Resources

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



Welcome to EmblemHealth

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

  • Provider Portal Training Materials

  • 2022 Summary of Companies, Lines of Business, Networks and Benefits Plans

  • 2022 Benefit Plans That Do Not Require A Referral

  • Medicaid/HARP/CHP Programs

  • Medicare Advantage Plans

  • Commercial Networks and Benefit Plans

  • Caring for Bridge Program Members

    Updated 11/10/21

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

    Updated 06/16/2021

  • 2021 Benefit Plans That Do Not Require A Referral

    Updated 04/15/2021

  • 2021 Medicare Advantage Guide

  • EmblemHealth Guide for Electronic Claims Submissions

  • Access and Availability Requirements

  • 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

  • “How Do I…” Provider FAQs

  • ConnectiCare Website Information


Your Plan Members


Access to Care and Delivery System


Medical Record Guidelines



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


Care Management

Visit Clinical Corner for practice guidance resources.


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



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


Additional Resources

  • Skilled Nursing Facility Quality Guide

  • 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

  • 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



  • Expired: Medicaid/HARP/CHP Resource Guide

  • Expired: 2020 Summary of Companies, Networks & Benefit Plans

  • Expired: 2020 Benefit Plans that Do Not Require a Referral

  • Expired: Helping Outreach to Individuals Eligible for Health and Recovery Plans and Behavioral Health (BH) Home and Community Based Services

  • Expired: Annual Plan News & Regulatory Reminders

  • Expired: Quality Measure Resource Guide

  • Expired: 2019 Network and Benefit Plan Updates

  • Expired: 2020 Medicare Advantage Guide

  • Expired: 2019 EmblemHealth Benefit Plans with No Referrals Required