Claims Submission Changes (EmblemHealth Provider Updates) Claims submission changes listed in the blog refer to some new demands for providers sending HIPAA claims to EmblemHealth. Starting October 1, 2018, eviCore began to process claims for radiology services performed by radiologists for ACPNY members. Claims sent to EmblemHealth after October 1, 2018 will be denied, indicating that the claim Read More →

Emblem Health HIPAA Claims Electronic Submission Emblem Health HIPAA Claims are received from thousands of health care practitioners that eliminated paper claims and are submitting electronic claims in HIPAA-compliant professional provider (837P), institutional provider (837I) and dental provider (837D) EDI claims transaction formats. When billing electronically, please allow a reasonable amount of time to complete your account Read More →

EmblemHealth Electronic Claims Submission Requirements EmblemHealth Electronic Claims should not be duplicated. When duplicate claims are submitted, vendor potentially delays claims processing and create confusion for the member. Attachments cannot be submitted electronically at this time. However, most claims should be submitted electronically. If supporting documentation is required for the settlement of a vendor claim, EmblemHealth will request it. Read More →

National Provider Identifier Requirements (EmblemHealth Electronic Claims Submission) National Provider Identifier (NPI) should be checked by vendor practice management system to ensure vendor software is capturing and correctly populating a National Provider Identifier (NPI) in electronic claims, otherwise claims will be rejected by EmblemHealth. Please note the following NPI requirements for electronic health care claim submissions: Professional Provider Read More →