A dedicated page of useful materials you can give your EmblemHealth patients to help manage their care and keep their costs down.
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Neighborhood Care
Provider Toolkit
Provider Toolkit
2020
Quality Measure Resource Guide
Welcome to EmblemHealth
Here is some information to help you get to know us and help you best serve our members, your patients.
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2020 Summary of Companies, Networks & Benefit Plans
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2020 Benefit Plans that Do Not Require a Referral
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EmblemHealth Quick Reference Card - Using our Secure Provider Portal
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Notice of Privacy Practices
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Guide for Managing Bridge Network Members
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2020 Medicare Advantage Guide
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How To Keep Your Directory Data Current
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Network Laboratory Services for All Plan Members
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Quest Diagnostics
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CDC’s Recommended Immunization Schedules
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HEDIS/QARR Medical Record Review and Clinical Data Collection
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Medical Record Audits
Claims
Visit Claims Corner for the latest information on our claims policies.
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Health Home Billing Guide - Under Revision
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EPO/PPO Corrected Professional Paper Claim Form
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National Provider Identifier (NPI) Reporting Sheet
Care Management
Visit Clinical Corner for practice guidance resources.
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Advise Your Patients to Visit Our Network Urgent Care Centers for Non-emergent Medical Care
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EmblemHealth Injectable Drug Utilization Management Program
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Medical Policies
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Domestic Abuse Guidelines
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Domestic Violence Confidentiality Protocols
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New York City Domestic Violence Resources
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The Office for the Prevention of Domestic Violence
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Quality Measure Resource Guide
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Confidentiality Policy Poster
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DVD to Promote Healthy Feeding of Newborns and Children Sent to New Mothers
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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.
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Visit Clinical Corner for formulary updates.
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2019 Medicare Part D Opioid Policies: Prescriber Tip Sheet
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2019 Medicare Part D Opioid Policies: Prescriber Webinar
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EmblemHealth Spine Surgery and Pain Management Therapies Program Guide
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Pain Management Prior Authorization Request Form
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Spinal Surgery Prior Authorization Request Form
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EmblemHealth Benefit Extensions Treatment Plan
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EmblemHealth Extension Request for a Current Authorization
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PT/OT Appeals Form
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.
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Join Our Networks
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Provider Manual
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Managed Care Law of 2009
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Medicare Advantage Addendum
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New York State Standard Clauses - April 2017
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Register for Access to Our Secure Website
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Get to Know Our Provider Home Page
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Take Advantage of Our Learning Opportunities
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Alcohol Abuse Screening Tool and Clinical Guidelines for Non-Mental Health Providers
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Behavioral Health Screening Toolkit for Primary Care Physicians
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Depression Screening Tool and Clinical Guidelines for Non-Mental Health Providers
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2018 Provider Networks and Member Benefit Plans chapter
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2017 Provider Networks and Member Benefit Plans chapter
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2016 Provider Networks and Member Benefit Plans chapter
