What is The Bridge Program?

Bridge is an innovative concept that gives our members access to a combination of our existing networks through our affiliated companies and partners.

Below are the five (5) networks that members may access.

If your practice has a contract with one of these networks, you can see Bridge Program members.

  • EmblemHealth Insurance Company’s (formerly HIPIC) Prime Network
  • EmblemHealth Plan Inc.’s (formerly GHI) National Network
  • ConnectiCare, Inc.’s Choice Network
  • QualCare Network
  • First Health Network

See all plans offering Bridge in a comprehensive summary of companies, lines of business, networks, and benefit plans.

If you participate in any of these networks, you are an in-network provider for Bridge Program members. The Frequently Asked Questions section below details how to determine if you may see a member with Bridge access and how you will be paid.

Sample Member’s ID Card

See the Member ID Card chapter of the EmblemHealth Provider Manual for a description of the logos shown on samples of all Member ID Cards. If the card says “Bridge” as shown below, the member has access to all five networks shown above..

Sample ID Card for EmblemHealth

Sample ID Card for ConnectiCare

How to Read the Member’s ID Card

Check the bottom right corner of the back of your Member’s ID card to match the correct administrative processes to follow below and discover which rules apply. See links for Utilization Management and Claims below the chart.


How to Read the Member’s ID Card

Check the bottom right corner of the back of your Member’s ID card to match the correct administrative processes to follow and discover which rules apply. See links for Utilization Management and Claims below the chart for more guidance.

Member's ID Card

Utilization Management

Claims Information


Preauthorization lists and UM programs follow non-City of New York EmblemHealth Plan, Inc. (Commercial)

Payor IDs, submission addresses, and processing rules follow non-City of New York EmblemHealth Plan, Inc. (Commercial)


Preauthorization lists and UM programs follow EmblemHealth Insurance Company

Payor IDs, subission addresses, and processing rules follow EmblemHealth Insurance Company


Preauthorization lists and UM programs follow ASO Client's instructions

Payor IDs, submission addresses, and processing rules follow EmblemHealth Insurance Company


Preauthorization lists and UM programs follow ConnectiCare coverage guidelines

Payor IDs, Submission addresses, and processing rules follow ConnectiCare billing and claims guidelines


Utilization Management

Preauthorization lists and UM programs follow non-City of New Work EmblemHealth Plan, Inc. (Commercial)

 

Claims Information

Payor IDs, submission addresses, and processing rules follow non-City of New York EmblemHealth Plan, Inc. (Commercial)


Utilization Management

Preauthorization lists and UM programs follow EmblemHealth Insurance Company

 

Claims Information

Payor IDs, subission addresses, and processing rules follow EmblemHealth Insurance Company


Utilization Management

Preauthorization lists and UM programs follow ASO Client's instructions

 

Claims Information

Payor IDs, submission addresses, and processing rules follow EmblemHealth Insurance Company


Utilization Management

Preauthorization lists and UM programs follow ConnectiCare coverage guidelines

 

Claims Information

Payor IDs, Submission addresses, and processing rules follow ConnectiCare billing and claims guidelines


Frequently Asked Questions

Bridge Provider:

It means:

  • Increasing the number of our members who may come to you for care.
  • Ensuring your staff knows how to identify these new members who can see you.
  • Following the underwriting company’s administrative guidelines.
  • Sending members to their designated utilization management programs.

You are considered in-network for a member seeking care if you are part of any of the networks listed below and the word “Bridge” appears on the member’s ID card.

  • EmblemHealth Insurance Company’s (formerly HIPIC) Prime Network
  • EmblemHealth Plan Inc.’s (formerly GHI) National Network
  • ConnectiCare, Inc.’s (CCI) Choice Network
  • QualCare Network*
  • First Health Network*

Look to the branding and instructions on the member’s ID Card. ID card will have “Bridge” in the network field and ConnectiCare, QualCare, and First Health logos.


*EmblemHealth and its affiliate ConnectiCare Insurance Company, Inc. partner with QualCare and First Health to provide coverage for certain of our benefit plans beyond our own contracted networks’ geographic coverage. These extended networks are considered in-network, based on their geography, for our members with the Bridge Program as follows:

QualCare = New Jersey Only

First Health Network = All States except:

  • Connecticut
  • Massachusetts’s 4 Counties (Berkshire, Hampden, Hampshire, and Franklin)
  • New Jersey
  • New York’s 28 Counties (Albany, Bronx, Broome, Columbia, Delaware, Dutchess, Fulton, Greene, Kings, Montgomery, Nassau, New York, Orange, Otsego, Putnam, Queens, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Schoharie, Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Payment:

If you participate with both EmblemHealth Insurance Company (formerly HIP Insurance Company of New York (HIPIC)) and EmblemHealth Plan Inc. (formerly Group Health Incorporated (GHI)) OR participate with both EmblemHealth Insurance Company and ConnectiCare (CCI), you will be paid according to your EmblemHealth Insurance Company contract terms. If you participate with both Health Insurance Plan of Greater New York (HIP) and EmblemHealth Plan Inc., EmblemHealth Plan Inc. rates will apply.  If you participate only with EmblemHealth Plan Inc. or only with CCI, you will be paid the respective contracted EmblemHealth Plan Inc. or CCI rate.

If you have a question or concern about which contract rate applies, see the chart below or contact us at 866-447-9717, Monday through Friday, from 8 a.m. to 6 p.m., and a Customer Service agent will assist you.

Contracts & Rates

Participation

Paid under this contract

EmblemHealth Insurance Company and ConnectiCare

EmblemHealth Insurance Company

EmblemHealth Insurance Company and EmblemHealth Plan Inc.

EmblemHealth Insurance Company

HIP and EmblemHealth Plan Inc.

EmblemHealth Plan Inc.

EmblemHealth Plan Inc. only

EmblemHealth Plan Inc.

ConnectiCare only

ConnectiCare

QualCare

QualCare

First Health

First Health

You follow the same billing protocols as you would for any other member falling under a given underwriting company and their applicable vendor partnerships.

See EmblemHealth Claims Contacts.

See ConnectiCare BIlling and claims information.

Utilization Management:

Referrals are not required. Follow the Utilization Management rules for the underwriting company found on the back of the Member’s ID Card.

See Who To Contact for EmblemHealth Preauthorization.

See Who To Contact for ConnectiCare Coverage guidelines.

Fully insured members follow all the standard administrative guidelines as every other member with the same benefit plan underwritten by the same company. This includes using the same preauthorization lists, preauthorization contacts, and special vendor managed utilization management programs.

The Bridge ASO program was initially launched with the goal of having all Bridge ASO members follow EmblemHealth Insurance Company’s standard utilization management rules. However, based on client request, we have given ASO clients the option to customize their utilization management rules. They may adopt an existing standard set of rules, or they may choose to develop their own.