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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.