Provider Toolkit | EmblemHealth

Switch to:

Provider Toolkit

Older woman reviewing chart with female doctor.

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

  • 2023 Summary of Companies, Lines of Business, Networks

  • 2023 Benefit Plans with No Referrals Required

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

    Updated 11/21/22

  • 2022 Benefit Plans That Do Not Require A Referral

    Updated 1/21/22

     

  • Medicaid/HARP/CHP Programs

  • Medicare Advantage Plans

  • Commercial Networks and Benefit Plans

  • Caring for Bridge Program Members

    Updated 11/10/21

  • EmblemHealth Guide for Electronic Claims Submissions

  • Access and Availability Requirements

  • Network Laboratories – Quest Diagnostics and LabCorp are our preferred clinical laboratories

    Updated 05/24/2022

  • 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

  • Reminder: Keep Your Directory Data Current

  • How To Keep Your Directory Data Current

  • Network Laboratories – Quest Diagnostics and LabCorp are our preferred clinical laboratories

    Updated 05/24/2022

  • Quest Diagnostics

  • EmblemHealth Neighborhood Care Physician Referral Form

  • New York Medicaid Statewide Patient-Centered Medical Home Incentive Program

  • Compare Hospitals

  • Skilled Nursing Facility Quality Guide

  • New York State Nursing Home Profile

  • DME Preauthorization Request Checklist

  • Appointment Availability Standards During Office Hours & After Office Hours Access Standards


 

Medical Record Guidelines


 

Claims

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. 

  • 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


 

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


 

Additional Resources

  • 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


 

Archive

  • Expired: 2021-2022 Annual Provider Notification

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

    Updated 06/16/2021

  • Expired: 2021 Medicare Advantage Guide

  • Expired: 2021 Benefit Plans That Do Not Require A Referral

    Updated 04/15/2021

  • Expired: 2021 Quality Measure Resource Guide

  • Expired: 2021 Medicaid/HARP/CHP Resource Guide

  • Expired: 2021 Summary of Companies, Networks & Benefit Plans

  • Expired: 2021 Benefit Plans that Do Not Require a Referral

  • Expired: 2021 Helping Outreach to Individuals Eligible for Health and Recovery Plans and Behavioral Health (BH) Home and Community Based Services

  • Expired: 2020 Medicare Advantage Guide

  • Expired: 2019 Network and Benefit Plan Updates

  • Expired: 2018 Annual Plan News & Regulatory Reminders

  • Expired: 2019 EmblemHealth Benefit Plans with No Referrals Required