EmblemHealth EPO/PPO Frequently Asked Questions
for Practitioners
1. Question: What is EmblemHealth?
Answer: EmblemHealth is the parent company of HIP and GHI, formed when the two
companies affiliated in 2006.
2. Question: What's the difference between EmblemHealth, GHI and HIP?
Answer: EmblemHealth is the parent company of HIP and GHI. We are now offering the
HIP and GHI products under the EmblemHealth name effective January 1, 2009, including a suite of choices featuring different benefits for affordable options. The existing HIP and GHI products are not withdrawn from the market and your patients will be able to continue seeing you under the same terms and conditions.
3. Question: How will this change my status with GHI and HIP?
Answer: This affiliation and the transition to the EmblemHealth name will not have any material impact on the agreement you have with either or both companies and the affiliation and the new branding of the products will not cause you to participate in any new provider network.
4. Question: Are all GHI PPO/EPO practitioners and facilities automatically participating in the EmblemHealth PPO/EPO network?
Answer: Yes.
5. Question: What geographical areas does EmblemHealth PPO/EPO cover?
Answer: These products are available to groups throughout New York State and for their
employees that reside in and outside of New York State.
6. Question: What products are available under the new EmblemHealth PPO/EPO plans?
Answer: There are six available products (3 PPO, 3 EPO):
- PPO
- InBalance PPO
- ConsumerDirect PPO
- EPO
- InBalance EPO
- ConsumerDirect EPO
7. Question: What are the Fee Schedules for both the EPO and PPO products?
Answer: Since the new EmblemHealth products are underwritten by GHI, you will be reimbursed at the GHI Fee Schedule.
8. Question: Do I need to be recredentialed to participate in the EmblemHealth PPO/EPO products?
Answer: No.
9. Question: When can I start to treat EmblemHealth PPO/EPO members?
Answer: These newly branded products will be available to members with a start date of
January 1, 2009. You may begin treating EmblemHealth members at that time.
10. Question: Will I have a different provider ID for the EmblemHealth PPO/EPO
products?
Answer: No. You will use the same provider ID that you currently use with GHI.
11. Question: Where should I send claims for EmblemHealth PPO/EPO members?
Answer: Send all claims to the address listed on the back of the member's ID card.
12. Question: How do I submit electronic claims for EmblemHealth PPO/EPO members?
Answer: If you are already submitting claims electronically for your GHI patients, you may submit claims for EmblemHealth PPO/EPO patients using the same payer ID number (13551).
13. Question: Are there any instances where the policies and procedures for treating
EmblemHealth PPO/EPO members differ from GHI's policies and procedures?
Answer: No.
Questions, Comments?
Send us feedback.
EmblemHealth, Inc. insurance plans are underwritten by Group Health Incorporated (GHI), HIP Health Plan of New York (HIP) and HIP Insurance Company of New York.
