New Claims Submission Address
for GHI's Healthy NY EPO Programs

 
January 2007

This communication provides administrative updates to GHI's Healthy NY EPO programs, including UNITE HERE! and the Brooklyn HealthWorks Healthy NY Program.

The GHI Healthy NY EPO programs provide basic health coverage, including optional prescription drug benefits. Members have access to GHI network providers in the Tri-State network. To be considered a network provider, you must be part of the CBP network, the Qualcare network in NJ or the Multiplan network in CT. Services received from non-network providers are not covered, except for emergency room care and emergency hospital admissions. Precertification is required for inpatient acute stays, ambulatory surgery, home care and transplants through GHI's Coordinated Care Department. Precertification for high tech radiology is required through CareCore National.

The claims processing administration for these programs moved from our Kingston facility to our New York City office on January 1, 2007. Please submit your GHI Healthy NY EPO claims for dates of service after January 1, 2007, along with your other CBP submissions to our New York City office. Use your 7-digit PPO Provider ID. Taking these steps will eliminate any delays in claims processing.

Please keep the following information handy:
  • Eligibility Information and Claim Status - For fastest service 24-hours a day, seven days a week, visit the Provider section of the GHI Web site. UNITE HERE! eligibility information can be obtained by calling UNITE HERE! directly at 1-800-636-6174.


  • Precertification: GHI's Coordinated Care Department 1-800-223-9870, Option 6
    CareCore National 1-800-835-7064


  • Claims Submission-For easy and fast claims submission, claims may be submitted electronically through the Emdeon (WebMD) Claims Clearinghouse Network using the GHI PPO Payer ID 13551 and with your 7-digit PPO Provider ID. Assistance on electronic submissions can be obtained by calling 212-615-4362.


GHI values your participation in our network and the high-quality care you provide to our members.

Sincerely,

Maria Martins-Lopes, MD, MS
Sr. Vice President and Chief Medical Officer