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April 2025
Office Visit
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EmblemHealth is a company built on decades of tradition, serving our members and the communities in which they live. Along the way, we have had many names—and understanding our current company names can help avoid confusion and allow you to see more members.
It is important for your practice to understand and be familiar with our most current EmblemHealth company names:
- Group Health Incorporated (GHI) (now known as EmblemHealth Plan, Inc.),
- Health Insurance Plan of Greater New York (HIP), and
- Health Insurance Company of New York (now known as EmblemHealth Insurance Company).
Remind your appointment schedulers and insurance verifiers to use the Check Provider Network Status look-up tool in the Provider Portal under the Member Management menu to see if you are a participating provider for a patient.
When a member calls for an appointment and says their insurance is EmblemHealth, they should not be denied an appointment because your original provider agreement says HIP or GHI. Take care to verify their eligibility and, if their benefit plan is one you can accept, welcome them into your practice.
New: Accumulators
We have added accumulators on the member Benefits and Eligibility Details page to show you how many claims we have received against certain benefits that may have limits. This will help you understand whether services you plan to provide will be paid for by our plan or whether you need to arrange payment with your patient.
New: Specialized Area
To submit updates to your NCQA-recognized Specialized Areas, please use the Ask a Question button located on the Provider Profile page in our provider portal. Specialized Areas is not a data element captured in the CAQH application. That is why you need to use our portal to communicate this information to us. Most changes should be submitted using CAQH. See Keep Your Directory Information Current for exceptions.
Sign in now to see the changes: EmblemHealth | ConnectiCare.
The following EmblemHealth Quality program materials have been updated and are available on the EmblemHealth provider website. Click below to view helpful information.
The Quality Incentive Program offers incentives to primary care providers at the group level for improving the quality of care for members. This program aims to improve access to essential care services, and support providers in delivering exceptional health outcomes.
The Maternity Quality Incentive Program offers incentives to OB/GYN providers for improving the quality of care for members during their pregnancy and postpartum period. This program aims to improve access to essential care services and support providers in delivering exceptional maternal health outcomes.
The Quality Measure Resource Guide provides details of quality measures, descriptions of documentation/coding, best practices, and steps to close care gaps. This guide will help you satisfy national and state quality measures that evaluate preventive, acute, and chronic care.
Our Member Rewards Programs can be used as a tool to engage with patients and encourage their regular visits, helping you boost patient retention and ensure consistent care. The programs are open to all EmblemHealth Medicare Advantage plan members, including those in a dual-eligible special needs plan (DSNP); Enhanced Care (Medicaid), Enhanced Care Plus (HARP), and Child Health Plus (CHPlus); and Essential Plan members.
In recognition of Mental Health Awareness Month, which is observed in May, we want to highlight the importance of medical care providers coordinating care of patients with mental health and substance use disorders.
When providing care, be sure to look out for signs of mental illness and refer members for behavioral health services, if needed.
We are here to help you understand and address their health care needs. Please review the resources below to help support mental health awareness:
EmblemHealth Behavioral Health | ConnectiCare Behavioral Health
Providers can help address and coordinate behavioral health care by:
- Screening for mental health conditions.
- Talking about the medications patients take so they can avoid potential harmful reactions.
- Encouraging and coordinating 7-day follow-up care after mental health-related emergency department/inpatient admissions.
- Helping connect members with a behavioral health specialist, if needed.
We are here to help.
EmblemHealth Members: For questions or help finding a behavioral health professional, please call Carelon at 888-447-2526. A representative can help 24/7. EmblemHealth members can stop by any of our Neighborhood Care locations for community support. Visit emblemhealth.com/neighborhood.
National Women’s Health Week begins on Mother’s Day each year to encourage women and girls to make their health a priority.
Women represent the cornerstone of a family's overall health. Ensuring they have access to quality care can also lead to improved health for children and families.
According to the Centers for Disease Control and Prevention (CDC), two out of every three caregivers in the United States are women. This means they provide daily or regular support to children, adults, or people with chronic illnesses or disabilities. Women who are caregivers have a greater risk for poor physical and mental health.
For tips on what you can do to support your female patients please visit our website.
The CDC also offers tips on what you can do to support your female patients.
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