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Frequently Asked Questions
Provider Help and Support | EmblemHealth
Our Provider Portal is designed to be simple and intuitive. Should you need help, we have posted a series of videos and user guides to help you step by step through each transaction.
We also created a frequently asked questions webpage to address the most common issues our Provider Customer Service team receives.
Here are some key things you need to know:
This portal is organized by Tax ID numbers. For each Tax ID, a user is assigned a role called User Type, which defines what information and transactions they can see. By default, new users have access to conduct business for all providers who share the same Tax ID.
Organizations that have more than one Tax ID can link them so each portal user can conduct business for all of the Tax IDs using their User ID and Password.
Billing company portal users who do business for multiple unrelated organizations can have a new Tax ID added to their existing portal accounts by using this Provider Portal Registration Form.
Administrator/Office Manager Role
Each provider/practice/facility needs to select someone to be their Administrator/Office Manager. That person is responsible for setting up new users, including their billing company’s staff, determining what transactions they can do (User Type or Role), and who they may conduct business for (if not everyone affiliated with the Tax ID).
The person who first activates the master account is automatically assigned the Administrator/Office Manager role. In support of HIPAA compliance, we are looking to our providers to manage their own users. Our Provider Customer Service team does not have the ability to set up individual users or change their portal access. If the person who activated the account will not be the ongoing Administrator/Office manager moving forward, the current Office Manager can reassign the role to the new Office Manager.
If you do not know your Portal Administrator or Office Manager and need assistance with setting up a new account or making changes to your account, please use the Provider Portal Registration Form and we will let you know who they are.
New Accounts
When a new provider joins our network, they may use the Provider Portal Registration Form to request a Registration Key to set up the account and add users.
If the practice/organization uses more than one Tax ID, each Tax ID will need to be registered. All registrations can be done using the same username, password/PIN, and email address so portal access for all Tax IDs is consolidated.
Identifying the Referring or Submitting Provider
For each transaction, the user must identify the provider they are submitting the transaction on behalf of. This is true even if the user is the provider or the user only has access to conduct business for one provider. This means searching for a Referring Provider for referrals, a Requesting Provider for preauthorizations, etc. You can search by name or by NPI. Company-issued provider IDs are no longer needed.
Non-Participating Providers
If you have ever submitted a claim and want to request a provider portal account now, fill out the short Provider Portal Registration Form.
The easiest way to see if you are in-network for a member is to use the Check Provider Network Status look-up tool in the Provider Portal.
Under the Member Management menu, select Eligibility or Check Provider Network Status.
- Search for the member. On the “Member Details” page, click the Check Provider Network Status button.
- Clicking the button carries the member’s information forward to a new screen. Search for the provider. (Network checks are limited to the provider themselves and their authorized portal Users.)
- The search results display the provider’s network status for that member in the right-most column in the results table.
You can watch the video and refer to the materials in this “Do I Need a Referral?” – A Quick Guide.
Tip: In the Provider Portal, you must select both the Referring and Servicing providers.
EmblemHealth’s claims payment process is managed by ECHO Health, Inc. See our Frequently Asked Questions document to see how claims are paid, how to sign up for EFT/ERA, and how to find your Explanations of Payment (EOP) and 835/ERAs. If you receive paper checks and want to be paid by EFT/ERA rather than virtual credit card, please wait until you have received your first virtual credit card payment before contacting ECHO at 888-492-0032. ECHO will help you make the switch.
You can find EmblemHealth medical policies in Clinical Corner. These medical policies reflect some of the information we consider when determining the medical necessity of certain services or supplies.
You can:
- submit electronic claims to EmblemHealth using the Payor IDs listed in the Claims Contacts chart in the Directory chapter of the provider manual.
- submit paper claims (CMS-1500 forms) to the addresses listed in the Claims Contacts chart, unless otherwise indicated on the member’s ID card.
For more information please click here.
Religio-Cultural Competency
Properly addressing religion is a key element of providing patient-centered care and improving health outcomes and patient and family satisfaction. That’s why we partnered with the Tanenbaum Center for Interreligious Understanding, a secular nonprofit organization dedicated to overcoming religious bias and intolerance, to create resources that help medical practitioners understand how religious beliefs and practices intersect with medical science. For more information, please see the Cultural Competency Continuing Education and Resources section of our Learning Online page.
Language Line: Interpreter Service
Free multi-language interpreter service is available to assist providers and their patients. Services are available in over 200 languages, including English, Spanish, Chinese Mandarin, Chinese Cantonese, Tagalog, French, Vietnamese, German, Korean, Russian, Arabic, Italian, Portuguese, French Creole, Polish, Hindi and Japanese. To access an interpreter, providers may call 1-866-447-9717 and a Provider Customer Care Advocate will assist you.
EmblemHealth has dedicated a web page of useful member materials on our Live Well site so your EmblemHealth patients can manage their care and keep their costs down.
Providers should verify member eligibility as outlined in the chart below.
| Confirm Member Eligibility | |
Provider Network |
Instructions |
Select Care Network Prime Network Bridge Program for plans underwritten or administered by EmblemHealth Insurance Company Enhanced Care Prime Network VIP Prime Network Bold Network Reserve Network Millennium Network |
|
Bridge Program for plans underwritten by EmblemHealth Plan, Inc. CBP, National & Tristate Networks |
|
| Medicare Choice PPO Network |
|
If you have ever submitted a claim and want to request a provider portal account now, fill out this short Provider Portal Registration Form.