Provider Toolkit

Provider Toolkit

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



Quality Measure Resource Guide
2020 Benefits Plans No Referrals
2020 Lab List


2019 EmblemHealth Benefit Plans with No Referrals Required
2019 Network and Benefit Plan Updates
ConnectiCare Website Information
ConnectiCare Members May Use Providers in the EmblemHealth Prime Network
Helping Outreach to Individuals Eligible for Health and Recovery Plans and Behavioral Health (BH) Home and Community Based Services
Annual Plan News & Regulatory Reminders
ConnectiCare Website Information
2018 Plan News & Regulatory Reminders

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


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

  • 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

  • Children and Family Treatment Support Services

  • Outreach to Individuals Eligible for HARP and Behavioral Health Home and Community Based Services

  • Behavioral Health Screening Tools

  • Mental Health Checkups for Adolescents

  • NIMH Treatment of Children with Mental Illness FAQ

  • Domestic Abuse Guidelines

  • eviCore healthcare

  • Quick Guide to EmblemHealth’s Radiation Therapy, Cardiology Imaging and Radiology Programs

  • EmblemHealth Radiation Therapy Program Clinical Pathways and Code List

  • Americans With Disabilities Act (ADA) Accessibility Attestation Form

  • Provider Credentialing Tool: CAQH Universal Credentialing Datasource

  • Provisional Credentialing Attestation Form

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

  • ASOT Agreement

  • ASOT Template

  • 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

  • Networks and Benefits

  • Reminder Keep Your Directory Data Current

  • Office of Health Insurance Programs Principles for Medically Fragile Children

  • Provider Quality Measure Resource Guide

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