Provider Toolkit

Provider Resources

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

 

2020

Quality Measure Resource Guide

Welcome to EmblemHealth

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

  • 2020 Summary of Companies, Networks & Benefit Plans

  • 2020 Benefit Plans that Do Not Require a Referral

  • EmblemHealth Quick Reference Card - Using our Secure Provider Portal

  • Access and Availability Requirements

  • 2020 EmblemHealth Contact Information – Frequently used numbers and websites

  • 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

  • ConnectiCare Members May Use Providers in the EmblemHealth Prime Network

  • 2020 Medicare Advantage Guide

  • “How Do I…” Provider FAQs

  • ConnectiCare Website Information





Claims

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

  • Health Home Billing Guide - Under Revision

  • 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

  • Supporting Your Patients with the Healthy Futures Program

  • EmblemHealth Injectable Drug Utilization Management Program

  • Medical Policies

  • Medical Technologies Database

  • Occupational Health Clinic Joins EmblemHealth

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

  • Information for Providers - Hepatitis C




  • Mental Health and Substance Abuse

    EmblemHealth strongly encourages care of the whole person. Please see screening tools and other valuable resources for the identification and treatment of mental health and substance abuse issues. 





Credentialing

See the Join Our Networks page and the Credentialing chapter of the EmblemHealth Provider Manual for our application instructions and credentialing and recredentialing policies, procedures and forms. 





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

  • 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

  • Office of Health Insurance Programs Principles for Medically Fragile Children

  • Provider Quality Measure Resource Guide


  • 2018 Provider Networks and Member Benefit Plans chapter

  • 2017 Provider Networks and Member Benefit Plans chapter

  • 2016 Provider Networks and Member Benefit Plans chapter

  • Helping Outreach to Individuals Eligible for Health and Recovery Plans and Behavioral Health (BH) Home and Community Based Services

  • Annual Plan News & Regulatory Reminders

  • Quality Measure Resource Guide

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