EmblemHealth offers a wide range of health plans. For many EmblemHealth members, referrals are not needed from their PCP before receiving care from a specialist. Still, we know that figuring out which plans require a referral may be confusing. Watch the two-minute video below that shows your practice how to find out if a member’s plan requires a referral.
A few quick ways to identify if your EmblemHealth member needs a referral
During the COVID-19 State of Emergency, all Medicare Advantage members will not need referrals.
How do I find which plans need referrals?
Use Provider Portal for Referral Transactions
Once you determine a referral is needed, use our Provider Portal to enter the Referral or to look up one sent to you. See how the Referral transactions work by reviewing the videos and guides under Referrals at the bottom of the Provider Portal Training Materials page.
TIP: To create a Referral, you must search for and enter the Referring Provider as well as the Servicing Provider.