#1 Emblem Health Credentialing Services & Emblem Health Provider Enrollment USA

Emblem Health Credentialing Services

Why Should You Go With Emblem Health?

Our organizations and Emblem Health share the same overarching mission: to serve our members with affordable, high-quality health care. We’re proud of our history of delivering helpful information and rapid, responsive service to our members, as well as offering your patients a variety of plan alternatives and collaborating with health care specialists.

If you’d like to join the hundreds of physicians, dentists, and clinicians who have partnered with Emblem Health, please begin the credentialing process by following the guidelines below.

Join Emblem Health’s Network: Before You Submit Your Application

Emblem Health has temporarily halted new provider applications for all networks unless the provider is joining one of the participating groups. HIP, Emblem Health Plan, Inc. (previously GHI), and Emblem Health Insurance Company are all affected by this stoppage (formerly HIPIC).
Our Network, which primarily serves non-Medicare retirees in the City of New York, is accepting new providers. Members can designate their preferred provider, and providers can apply for their practices are the address to send applications to. Providers that want to service participants in the new NYC Medicare Advantage plus Plan, which will start in 2022, must also be a part of our Commercial network.

Who Will Be in Charge Of My Credentialing?

Emblem Health collaborates with a variety of organizations to provide value-based care, administrative efficiency, and specialized expertise to our members. Emblem Health has struck into arrangements with these partners to execute credentialing on its behalf where applicable. Emblem Health has a rigorous oversight procedure in place to guarantee that our partners live up to our high expectations. Health care practitioners may be required to sign direct agreements with these partners and go through their certification processes in certain instances.

You may need to apply for participation through one of Emblem Health’s partners depending on your specialization or practice affiliation.
Expand the next two tabs to check if your specialization or practice has its own set of procedures that you must follow.

Application for CAQH®

The Council for Affordable Quality Healthcare (CAQH) ProView® credentialing application form is required of all Emblem Health network applicants. Please register with CAQH ProView if you do not have a CAQH number. Please contact CAQH at 888-599-1771 if you have any concerns about how to receive a CAQH number.

Is itTime to Submit My Documents?

All documentation are submitted electronically to Emblem Health. Please do not send hard copies in the mail.

Please double-check this list to ensure you have everything you require. Please double-check that everything is completed and accounted for. The credentialing procedure will be slowed down if there is any missing or confusing information.

Each And Every Application Must Include

One CAQH application for each site, including the most recent signed/dated W-9 ADA attestation (must utilize the Emblem Health form) (Please note: An ADA attestation is not needed for GHI PPO.)
If appropriate, the signature page of the Emblem Health Plan, Inc. Participation Agreement. Contracts will be provided to you if you apply to one of our other firms and meet network requirements.
Multiple doctors submitted under one contract or a doctor(s) added to an existing contract.
The questions on the Provider Credentialing Form about group involvement must be answered, and the TIN must match the one on the W-9.

There Are No Admission Privileges

Agreement on Covering Providers (if no current hospital privilege is recorded in CAQH)
A Transfer Agreement between the group and the hospital may be included
A Linkage Agreement between the group and the hospital could be part of this

Practitioners Who Aren’t Doctors

Application for certification as a PA (addendum for Physician Assistants)
Application for NP Credentialing (addendum for Nurse Practitioners)
Attestation form for NP Collaborative Relationships (Applicable to NPs with more than 3,600 hours)
Collaborative Agreement with NP (Less than 3,600 hours, if applicable)
Only Medicaid Providers

Form for Medicaid Compliance Certification (Disclosure Certification)

Your application must be thorough and contain current information about the clinician(s) you wish to credential in order for us to credential new clinicians swiftly, efficiently, and accurately. Before submitting your application, double-check the accuracy of the service and billing addresses. Before submitting your next provider credentialing application to us, please examine our Council for Affordable Quality Healthcare (CAQH) Application Tips.

We use phone calls to verify the accuracy of your addresses at Emblem Health. Locations whose information is discovered to be erroneous will be barred from participating. This also covers the service address’s accuracy. We’ll double-check that the practitioner accepts patients at that location and that the phone number provided is for scheduling appointments. Appointment availability and provider accessibility are audited by Emblem Health, the New York State Department of Health, and the Centers for Medicare & Medicaid Services on a regular basis. See our Access and Availability Requirements for more information.

Examine and fill out all required information. The application will be returned if any required information is missing or incomplete. A complete application must be filed before the provider can be credentialed.

Where Should I Send My Filled-Out Forms?

Send an email with your application

Please email your completed application and agreement(s) to [email protected] for applicants in New York City’s 5 boroughs, Nassau and Suffolk counties, as well as New Jersey and Connecticut.
Please email your full application and agreement(s) to [email protected] for applicants from all other counties in New York State and other states.
All applications for the PPO Dental Networks should be submitted via the process outlined on the Join Our Dental Networks page, and should be sent to [email protected] with your completed application and agreement(s).
Please note that the email addresses shown above are solely for new application submissions. Provider Services can be reached at 866-447-9717 for status updates. Please wait at least 45 days before contacting us to inquire about your status.

What Happens After That?

If additional information is required, our Credentialing team will contact you.
Before checking on the status of your application, we recommend waiting at least 45 days. Call our Provider Services Line at 866-447-9717 to check your status.
You can check your practice profile to see whether your participation has changed if you have an account for our secure provider portal, emblemhealth.com.
Every 120 days, CAQH requires suppliers to confirm their data. The CAQH application is used for credentialing every three years. Please keep your information up to date so Emblem Health may continue to be an authorized plan.

Benefitsof Collaborating with Us

Ensure that quality is maintained

As previously said, the medical credentialing procedure ensures quality in the healthcare industry. It’s a way of medical industry evaluation that helps to ensure that the medical community’s quality standards are continuously met for the sake of patients. In order to keep costs down, insurance companies prefer to give preference to medical doctors and practices who have proved expertise in their fields.

Patient safety must be maintained

Credentialing ensures that practices and physicians have the experience and abilities needed to perform treatments of patients, which helps to preserve patient safety. The procedure aims to lessen the risk of medical errors caused by inexperienced healthcare providers. Credentialing helps to reestablish trust between patients and medical practitioners by providing all of this background information. Patients can put their full trust in their physicians’ competence if they know they have the qualifications and merit to be their chosen providers.

Prevent Revenue Loss

Medical offices might lose thousands of dollars in revenue due to delayed or denied reimbursements if they are not properly credentialed. Insurance companies may refuse to reimburse medical practitioners for treatments if they fail to obtain proper credentialing or make mistakes throughout the process. If a medical practice allows a physician to provide services prior to or during the credentialing process, the insurance payer may be entitled to reimburse the treatments.

Boost Your Patient Count

Physician credentialing lets medical practitioners to access previously inaccessible patient bases by allowing them to accept health-insurance-covered paints. The vast majority of Americans have health insurance policies; in 2019, 92 percent of Americans were covered by health insurance. This helps medical practices to expand their client base and potentially improve revenue.

Improve Your Practice’s Image

Before committing to a healthcare practice or a physician, more patients are investigating them than ever before. This could entail looking into their background or patient reviews on the internet. One of the most effective strategies to improve your reputation is to undergo medical credentialing. When potential patients look up your medical practice, credentials indicate that it is well-established, respected, and trustworthy.

Improving the Hiring Process

When a physician is a benign accreditation, they must through examination that looks into their personal history, school background, professional experience, and any other qualifications. If your medical practice is employing a qualified medical practitioner, this method can confirm that they are capable of performing the job description requirements.

Provide a Competitive Advantage

Medical offices must discover strategies to differentiate themselves in the competitive world of healthcare. Medical credentialing demonstrates to potential new patients that your medical practice employs specialists with relevant experience. Furthermore, being credentialed can assist you in recruiting well-qualified physicians, who are more likely to join a credentialed practice with a larger patient base than one that isn’t. The medical credentialing process gives your medical practice an advantage over competitors in your industry and allows you to keep growing.