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Provider Toolkit

Provider Toolkit

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

 

Recently Added

2019

2019 EmblemHealth Benefit Plans with No Referrals Required
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2019 Network and Benefit Plan Updates
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ConnectiCare Website Information
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ConnectiCare Members May Use Providers in the EmblemHealth Prime Network
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Helping Outreach to Individuals Eligible for Health and Recovery Plans and Behavioral Health (BH) Home and Community Based Services
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EmblemHealth Provider Manual Chapter List
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Welcome to EmblemHealth

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

  • 2019 Networks and Benefit Plans Brochure

  • 2019 Benefit Plans that Do Not Require a Referral

  • EmblemHealth Quick Reference Card - Using our Secure Provider Portal

  • Access and Availability Requirements

  • 2019 EmblemHealth Contact Information – Frequently used numbers and websites

  • Provider Manual Chapter Overview

  • Network Laboratories – Quest Diagnostics is our preferred clinical laboratory

  • PNC Remittance Advantage – Frequently Asked Questions about Electronic Funds Transfer and Electronic Remittance Advice

  • Improving the Patient Experience

Your Plan Members

  • Transition to New Medicare Numbers and Cards Fact Sheet

  • Notice of Privacy Practices

  • Welcome to the Select Care Network, a Quick Reference Guide

  • Welcome to Enhanced Care Prime Network for HARP and Essential Plan

  • In Our Prime, A Comparison of the Prime Network and Select Care Network

  • Guide for Managing Bridge Network Members

Access to Care and Delivery System

  • How To Keep Your Directory Data Current

  • EmblemHealth Contact Information

  • Network Laboratory Services for All Plan Members

  • Quest Diagnostics

  • 2019 EmblemHealth Benefit Plans with No Referrals Required

  • EmblemHealth Contact Information for Medicare Advantage HMO

  • EmblemHealth Neighborhood Care Provider Recommendation Pad Cambria Heights

  • EmblemHealth Neighborhood Care Provider Recommendation Pad Harlem

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

  • Preventive Health Guidelines

  • Compare Hospitals

  • New York State Nursing Home Profile

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

Medical Record Guidelines

  • CDC’s Recommended Immunization Schedules

  • HEDIS/QARR Medical Record Review and Clinical Data Collection

  • Medical Record Audits

  • Medical Record Review Tools

Claims

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

  • Health Home Billing Guide

  • EPO/PPO Corrected Professional Paper Claim Form

  • National Provider Identifier (NPI) Reporting Sheet

  • PNC Remittance Advantage: 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

  • EmblemHealth Injectable Drug Utilization Management Program

  • Medical Policies

  • Medical Technologies Database

  • PATH Programs

  • Occupational Health Clinic Joins EmblemHealth

  • Dignified Decisions – End of Life Care Program Referral Form for Hospice

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

  • Information for Providers - Hepatitis C

Domestic Violence Resources

  • Domestic Abuse Guidelines

  • Domestic Violence Confidentiality Protocols

  • New York City Domestic Violence Resources

  • The Office for the Prevention of Domestic Violence

Health Promotion and Disease Management

  • Medicare Health Outcomes Survey (HOS): An Overview for Providers

  • Medicare Health Outcomes Survey (HOS): Provider Tips

  • Confidentiality Policy Poster

  • Disease Management (DM) PATH

  • DVD to Promote Healthy Feeding of Newborns and Children Sent to New Mothers

  • ExerciseRewardsTM Program

  • Free Services for You and Your Alzheimer’s Patients

  • Health Care Proxy

  • Health Survey for Adolescents

  • Healthy Beginnings PATH Fast-Fax Form

  • Healthy Tips Teens Need to Know

  • Help Support Breast feeding

  • HIV/AIDS Case Management

  • Member Flyer - Lower Your Cost of Care

  • NYSDOH LGBT HIV Health

  • Prenatal Program for Medicaid

  • Provider Weight Management Resources

Behavioral Health Services

  • Children and Family Treatment Support Services

  • Outreach to Individuals Eligible for HARP and Behavioral Health Home and Community Based Services

  • Behavioral Health Screening Tools

  • Mental Health Checkups for Adolescents

  • NIMH Treatment of Children with Mental Illness FAQ

  • Domestic Abuse Guidelines

Pharmacy Services

  • Visit Clinical Corner for formulary updates.

  • 2019 Medicare Part D Opioid Policies: Prescriber Tip Sheet

  • 2019 Medicare Part D Opioid Policies: Prescriber Webinar

  • Addition to Formulary Request Form

  • EmblemHealth Injectable Drug Utilization Management Program

  • EmblemHealth Medicaid Formulary Search

  • High Risk Medications for Elderly Patients

  • Medicaid Prior Authorization Request Form

  • Medicare Requirement for Prescribing Part D Drugs

  • Non-FDA-Approved Drug Use and/or Dose Request Form

  • Physician Specialty Program Enrollment Form

  • Potentially Inappropriate Medication Use in Older Adults

  • Prior Authorizations with PromptPA

  • Standing Orders for Influenza Vaccination and Other Vaccinations

  • Vaccines for Children (VFC)

  • Prescribing eHealth Initiative Best Practices and Guidance

EmblemHealth Spine Surgery and Pain Management Therapies Program

  • EmblemHealth Spine Surgery and Pain Management Therapies Program Guide

  • Pain Management Prior Authorization Request Form

  • Spinal Surgery Prior Authorization Request Form

Radiation Therapy, Cardiology Imaging and Radiology Programs

  • eviCore healthcare

  • Quick Guide to EmblemHealth’s Radiation Therapy, Cardiology Imaging and Radiology Programs

  • EmblemHealth Radiation Therapy Program Clinical Pathways and Code List

Physical and Occupational Therapy Program

  • EmblemHealth Benefit Extensions Treatment Plan

  • EmblemHealth Extension Request for a Current Authorization

Credentialing

  • Americans With Disabilities Act (ADA) Accessibility Attestation Form

  • Provider Credentialing Tool: CAQH Universal Credentialing Datasource

  • Provisional Credentialing Attestation Form

Regulatory Mandatory Reporting

  • Communicable Disease Reporting and Resources

Fraud and Abuse

  • EmblemHealth Standards of Conduct

Required Provisions To Network Provider Agreements

  • Managed Care Law of 2009

  • Medicare Advantage Addendum

  • New York State Standard Clauses - April 2017

  • Special Provisions Related to Medicaid, CHIP and HARP Members

Tips and Tools

  • Register for Access to Our Secure Website

  • Get to Know Our Provider Home Page

  • Take Advantage of Our Learning Opportunities

  • Sleep Studies

Additional Resources

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

  • ASOT Agreement

  • ASOT Template

  • 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

  • Networks and Benefits

  • Reminder Keep Your Directory Data Current

Archive

  • 2018 Provider Networks and Member Benefit Plans chapter

  • 2017 Provider Networks and Member Benefit Plans chapter

  • 2016 Provider Networks and Member Benefit Plans chapter

EmblemHealth Spine Surgery and Pain Management Therapies Program

  • EmblemHealth Spine Surgery and Pain Management Therapies Program Guide

  • Pain Management Prior Authorization Request Form

  • Spinal Surgery Prior Authorization Request Form

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© 2019 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.