Hospitals Must Use the Medicare Outpatient Observation Notice
Starting on March 8, 2017, all hospitals must give written and oral notice to anyone getting observation services as an outpatient for more than 24 hours. The form, Medicare Outpatient Observation Notice (MOON), includes the reason and effects of receiving outpatient services. This is required by the federal Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act.
Tips for Better Patient Communication
Be an active listener.
Use language that is easy to understand.
Use our Language Line. Call 1-866-447-9717 to find a translator.
Involve patients in decision making.
Practice cultural sensitivity.
End the visit with "Do you have any questions?"
Update to City of New York HMO/PPO PBA Member Benefits
The Tiered Benefit Product is now available to members of the Patrolmen's Benevolent Association (PBA). This benefit offers lower costs for members who choose preferred in-network doctors. Members will pay higher copays if they visit non-preferred providers. New ID cards have been sent to affected members. See our Policy Alert for all plan benefits.
Target and CVS Pharmacies Are No Longer In Network for Medicaid and HARP Members
When a given site is injected, it will be considered one service, no matter how many injections are given.
Support Medicaid Recertification
Remind Medicaid members to recertify before their Eligibility End Date. If members do not recertify on time, they will lose coverage and be forced to reapply. Here’s how to determine end dates.
Tell Us What You Think
You may have recently received our Physician Satisfaction Survey by mail and fax. Please take a few minutes to fill out this brief survey. Your input is vital because we want to make it easier for you to work with us.
Use Quest Diagnostics
Quest is our preferred, free-standing, independent commercial lab for members. Please direct our members to the nearest Quest Laboratory Patient Service Center. If you need to set up an account with Quest, please call 1-866-697-8378.
For specialty lab tests not available from Quest, you may use one of the other contracted, free-standing, independent commercial labs or contracted hospital labs.
After login, health care professionals can check eligibility and get an up-to-date member Panel Report, listed under My Reports. To learn more, Take a Tour today.
Keep Your Directory Information Current
Know Your Network Participation
Your provider profile lists your network affiliations. To view it, please log in to your Provider/Practice Profile on our secure provider portal at emblemhealth.com. If your network affiliation matches the network on the member's ID card, then you are in-network for that member's benefit plan. See the Provider Networks and Member Benefit Plans chapter of the EmblemHealth Provider Manual
for a listing of all networks and plans.
Commercial Coordination of Benefits 837D Electronic Claims Transactions
Did you know EmblemHealth accepts electronic dental claims for payment as a secondary insurance carrier? Learn more about the benefits of electronic claims.
We partner with the New York State Smokers Quitline to get our members to quit smoking. If you have patients ready to quit, urge them to call the New York State Quitline at 1-866-NY-QUITS (1-866-697-8487), or 1-877-500-2393 for non-NY residents. Add the five As of assessment to all your visits and get paid for patient counseling.
EmblemHealth Partners with DentaQuest
DentaQuest now manages the dental benefits for members in the these networks:
Enhanced Care Prime
Premium (aka Vytra Premium)
It includes use of out-of-area benefits (via Careington) through our Preferred/Plus Dental Network. Go to dentaquest.com for more details, or call them at 1-844-822-8108, Monday to Friday from 8 am to 5 pm.
The Medical Policies page has a large list of medical technologies reviewed by the Medical Policy Subcommittee for coverage consideration. Below is a list of policies that have changed.
Help Your Patients’ Compliance - Improve Your Cultural Competency
Make sure your patients know what they need to do after an office visit. If they don't understand what they have to do, they can't comply. If language is a barrier, use the EmblemHealth Language Line for: