Starting December 1, GHI PPO transition to Self-Referral Payment Policy

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Starting October 1, GHI PPO transition to Self-Referral Payment Policy


Date Issued: 7/1/2019

Effective October 1, 2019, EmblemHealth will begin transitioning GHI PPO members from the Radiology Privileging Program to the Outpatient Imaging Self-Referral Payment Policy (SRPP) currently managed by eviCore for HIP members.

To start, SRPP will apply to non-City GHI PPO members who have been migrated to our new systems and have been given new member IDs. The ID will start with the letter “K” followed by a unique 8-digit number. The final two digits refer to the covered individual in relationship to the subscriber. As members renew their plans and are given new IDs, SSRP will apply.

SRPP promotes appropriate use of diagnostic imaging by our network providers in an office setting (POS 11). This policy designates the minimum accreditation and certification requirements for specific imaging procedures performed by designated provider specialties. Only providers who meet the requirements will be reimbursed for these services.

If you provide radiology services in your office, review the Self-Referral Payment Policy chapter of the EmblemHealth Provider Manual to see whether you will meet the criteria of the SRPP and be eligible for payment.EmblemHealth’s Quality Management department is required to conduct several medical record audits each year for regulatory reporting and quality assurance purposes. The medical audit field team consists of nurses and non-clinical support. When on site, the team will answer any questions you may have.

If you are contacted to supply medical records for these audits, you are encouraged to respond as expeditiously as possible. Rest assured that in supplying the requested records to EmblemHealth, you are in no way violating any HIPAA privacy rules.