Office Visit
Feature Stories
Getting Help With Portal Account Setup
Setting up new users and managing portal accounts is the responsibility of your provider portal administrator/office manager (administrator) and their designees. There are situations, however, when you will need assistance. We created a new Provider Portal Account Request form to help when:
- Someone doesn’t know who within their organization can set up a portal account.
- A new tax identification number (TIN) needs a new master account.
- The designated administrator left the organization without setting up a replacement.
- A user account already exists and a TIN for a different, unrelated practice, facility, agency, etc., needs to be added to their existing account.
- The encrypted form can be found on (EmblemHealth | ConnectiCare). The data is stored in a HIPAA-compliant database.
Customer Service for Billing Companies
As shared in the August edition of Office Visit, starting Oct. 1, 2023, we require third-party billing companies to use our provider portal before calling us. We find that in most cases, the answers to billing company questions are readily available on our provider portal. When the information is not there, the issue is generally more complex and requires thoughtful research to determine the correct response.
Billers can start a dialog with Provider Customer Service by looking up a specific claim and asking a question. Alternatively, they can download a custom report to isolate a set of claims they want to address. Once the dialog is opened, they can use the Message ID and Conversation ID in the Message Center to continue the conversation.
Please share these web pages with your billers so they can see the best way to use the portal to work with us:
- Billing Specialists: Use Our Portal to Simplify Accounts Receivables for EmblemHealth Members
- Where to Submit Information Using the Provider Portal
- Provider Portal: Addressing Denied Claims
- Billing Specialists: Need Explanations of Payments (EOPs)? Find Them on Our Provider Portal
If you are working with a new billing company that has established accounts for our portals, they can use the new Provider Portal Account Request form (EmblemHealth | ConnectiCare) so we can assist in linking your TIN to their existing account. Otherwise, the administrator for your organization can create new accounts for your billers only if they are using email addresses that have never been registered before. This new form may also be used when someone in a large organization needs help finding their administrator.
While it may seem counterintuitive to move from a phone call to a message exchange, we believe it will enable us to get to quicker, better resolutions in the long run. In the event a phone call is really needed, the biller will be asked to provide the Message ID from the portal so the Customer Service representative can quickly get to the open dialog.
Effective Dec. 19, 2023, EmblemHealth and ConnectiCare will no longer enter provider information into our system – under any circumstances – with a retroactive effective date.
Provider groups and individual providers are expected to submit any provider or practice additions, terminations or removals, and billing or general changes in advance of the effective date of that change. Notwithstanding any regulatory, credentialing, or contract considerations, the earliest possible effective date of such a change will be the date that we receive all necessary information in accordance with EmblemHealth and ConnectiCare policies and procedures.
Also see Keep Your Directory Information Current below.
Value-Based Care Study Shows Strong Preference by Consumers, Employers
EmblemHealth recently shared results from its national study exploring the level of awareness of value-based care payments among employers and consumers. The study revealed that both groups are unclear on the difference between value-based care and fee-for-service payments. However, when provided a definition of value-based payments, both groups strongly preferred this model as the best way to receive the highest quality care that may also reduce costs.
“The survey data and information from our research demonstrate that both employers and consumers overwhelmingly prefer value-based care to fee-for-service payment models when they better understand the differences between each model,” said EmblemHealth’s Chief Executive Officer Karen Ignagni. “Achieving healthier outcomes more affordably will require all stakeholders to work together to educate the public on the benefits of a value-based care model.”
The study surveyed nearly 125 employer health insurance decision-makers and nearly 750 consumers ages 18 and older nationally, with a focus on EmblemHealth’s core tristate region. The value-based care white paper, “Moving from Volume to Value: Explaining the Difference Between Fee for-Service and Value-Based Payments,” is available now and includes detailed study findings and recommendations on how employers and consumers can be better informed about the differences between fee-for-service and value-based care payment models.
Click here to read our public announcement featuring highlights from the study, including the importance consumers and employers place on quality care.
EmblemHealth has earned Health Equity Accreditation from the National Committee for Quality Assurance (NCQA) for our commercial HMO and POS products, Medicaid HMO products, and Medicare HMO products. EmblemHealth is the first insurer in New York State to receive accreditation across three product lines.
As a nonprofit health insurer serving this region for over 80 years, EmblemHealth works to address health equity issues through our provider network and directly with our members through our Neighborhood Care sites strategically located across the city. We appreciate the collaboration of our provider partners, especially in supporting important quality and public health initiatives as promoted each month in Office Visit.
“We are committed to reducing health inequities in our members and the communities we serve,” said Abdou Bah, senior vice president and chief health equity officer at EmblemHealth. “This award recognizes our work in meeting New Yorkers where they are in their personal health journey and closing gaps in care.”
To learn more about this NCQA accreditation and the work that went into achieving this recognition, click here for our public announcement.
MD Perspectives
In anticipation of National Depression Screening Day, Thursday, Oct. 5, 2023, Kelly McGuire, MD, MPA, our medical director of psychiatry, shares her thoughts about tools available for you to screen your EmblemHealth and ConnectiCare members for depression.
September is Healthy Aging Month. It’s a good time to speak to your patients about healthier habits and encourage them to plan responsibly for their futures.
Thinking about our own mortality and possible incapacity can be very uncomfortable for people. Yet, as clinicians we need to help our patients confront these difficult topics, make decisions, document them, and be sure we have copies of any decisions in their medical records. Hear from former senior medical director of population health and clinical engagement, Lama El Zein, M.D., M.H.A., as she shares her thoughts on Healthy Aging.
Also see the screening for depression and advance care planning resources added to the Programs, Classes, and Resources page.
If there are other health topics you would like our perspectives on, please write to us at emblemhealthmedicaldirectors@emblemhealth.com.
While we welcome your suggestions, we ask that you do not send protected health information (PHI) or patient-specific issues to this mailbox. This mailbox should not be used for complaints, grievances, appeals, or claims inquiries. The Claim Inquiry and Message Center features in the provider portals (EmblemHealth | ConnectiCare) should be used for those issues.
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