DIRECTORY

Transcription

DIRECTORY
DIRECTORY
TABLE OF CONTENTS
. . . . . . . . . . . . . . . . . . . .HEADQUARTERS
EMBLEMHEALTH
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. . .
. . . . . . . . . . . . . .SERVICE
CUSTOMER
. . . . . . . . . (PROVIDERS)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. . .
. . . . . . . . . CONTACTS
CLAIMS
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. . .
. . . . . . . . . . . PHARMACY
CLINICAL
. . . . . . . . . . . . . .SERVICES
. . . . . . . . . . . (PRACTITIONERS)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. . .
. . . . . . . . .PHARMACY
RETAIL
. . . . . . . . . . . . . SERVICES
. . . . . . . . . . . (PHARMACIES)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. . .
. . . . . . . . . . . . . . . HEALTH
BEHAVIORAL
. . . . . . . . . .SERVICES
. . . . . . . . . . . (PRACTITIONERS
. . . . . . . . . . . . . . . . . . . AND
. . . . . .MEMBERS)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
....
. . . . . . .TO
HOW
. . . .OBTAIN
. . . . . . . . .PRIOR
. . . . . . . APPROVAL
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
....
. . . . . . . . . . . . . . . . SERVICES
LABORATORY
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
....
. . . . . . . . . . CARE
URGENT
. . . . . . .CENTERS
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
....
. . . . . . . . . . . . . . . . GRIEVANCES,
COMPLAINTS,
. . . . . . . . . . . . . . . .AND
. . . . . .APPEALS
. . . . . . . . . .(PRACTITIONERS
. . . . . . . . . . . . . . . . . . . AND
. . . . . .MEMBERS)
. . . . . . . . . . . . . . . . . . . . . . .14
....
. . . . . . . . . . . . . . . RESOURCES
ADDITIONAL
. . . . . . . . . . . . . . (PROVIDERS
. . . . . . . . . . . . . . AND
. . . . . .MEMBERS)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
....
. . . . . . . . . . . . RESOURCES
SELECTED
. . . . . . . . . . . . . . FOR
. . . . . MEMBERS
. . . . . . . . . . . .WITH
. . . . . . SPECIAL
. . . . . . . . . .NEEDS
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
....
. . . . . . . . . . . .FOR
SERVICES
. . . . .THE
. . . . .VISUALLY
. . . . . . . . . . .IMPAIRED
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
....
. . . . . . . . . . . . . . FOR
RESOURCES
. . . . . CHILDREN
. . . . . . . . . . . . .WITH
. . . . . . SPECIAL
. . . . . . . . . .NEEDS
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
....
. . . . . . . . . . . . . .SERVICE
CUSTOMER
. . . . . . . . . (FOR
. . . . . . MEMBERS)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
....
. . . . . . . . . . . . . .SERVICES
PHARMACY
. . . . . . . . . . . (FOR
. . . . . . MEMBERS)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
....
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EmblemHealth Provider Manual
Last Updated: 09/03/2014
4
DIRECTORY
This chapter contains contact information for parties within EmblemHealth, our delegated
relationships and other external resources.
EMBLEMHEALTH HEADQUARTERS
EmblemHealth
55 Water Street
New York, NY 10041-8190
CUSTOMER SERVICE (PROVIDERS)
CUSTOMER SERVICE (PROVIDERS)
EmblemHealth
1-877-842-3625, seven days a week (excluding major holidays), 8 am to 8 pm
TTY/TDD: 711
All LOBs may be accessed through our message Center at www.emblemhealth.com
EmblemHealth Medicare HMO
1-877-344-7364, seven days a week (excluding major holidays), 8 am to 8 pm
TTY/TDD: 711
EmblemHealth Medicare PPO
1-866-557-7300, seven days a week (excluding major holidays), 8 am to 8 pm
TTY/TDD: 711
GHI
1-800-624-2414, seven days a week (excluding major holidays), 8 am to 8 pm
Also NYC: 1-212-501-4444
TTY/TDD: 711
GHI HMO
1-877-244-4466, seven days a week (excluding major holidays), 8 am to 8 pm
TTY/TDD: 711
HIP and HIPIC
1-800-447-8255, seven days a week (excluding major holidays), 8 am to 8 pm
HIP and EmblemHealth CompreHealth EPO
1-866-447-9717, Monday through Friday, 9 am to 5 pm
Vytra
1-888-288-9872
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Last Updated: 09/03/2014
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DIRECTORY
CLAIMS CONTACTS
CLAIMS CONTACTS
Clearing House
Submission
Address
Contact for
Inquiries
All claims
(except
55247
anesthesiolog
y)
Emdeon or
direct
submission
EmblemHealt
h
PO Box 2845
New York, NY
10116-2845
www.emblem
health.com or
1-866-447-97
17
EmblemHealt
h
Anesthesiolog
55247
CompreHealt y claims
h EPO
Emdeon or
direct
submission
EmblemHealt
h
PO Box 2787
New York, NY
10116-2787
www.emblem
health.com or
1-866-447-97
17
55247
Emdeon or
direct
submission
EmblemHealt
h Medicare
HMO
PO Box 2803
New York, NY
10116-2830
www.emblem
health.com or
1-866-447-97
17
13551
Emdeon or
direct
submission
EmblemHealth
Medicare PPO
PO Box 2830
New York, NY
10116-2830
13551
Emdeon or
direct
submission
EmblemHealt
h
www.emblem
PO Box 2832
health.com
New York, NY
10116-2832
13551
Emdeon or
direct
submission
GHI Claims
PO Box 2832 www.emblem
New York, NY health.com
10116-2832
Emdeon or
direct
submission
www.emblem
health.com,
1-877-244-44
66 or:
GHI HMO
GHI HMO
PO Box 2845 Attn:
New York, NY Provider
10016
Corresponde
nce
PO Box 2844
New York, NY
Plans
Type of Claim
EmblemHealt
h
CompreHealt
h EPO
EmblemHealt
h Medicare
All claims
HMO
EmblemHealth
Medicare PPO
All claims
EmblemHealt
All claims
h EPO/PPO
GHI (New
York City and
all other areas
All claims
outside of
New York
State)
GHI HMO
All claims
EDI or Payor ID
25531
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www.emblem
health.com
EmblemHealth Provider Manual
Last Updated: 09/03/2014
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DIRECTORY
CLAIMS CONTACTS
Plans
Type of Claim
EDI or Payor ID
Clearing House
Submission
Address
Contact for
Inquiries
10016-2844
HIP
HIP
Select Care
Network-Based
Plans
Vytra
All claims
(except
55247
anesthesiolog
y) Anesthesiolog
55247
y claims
All claims
All claims
55247 22264
GHI /
Not
EmblemHealt Dental claims
applicable
h Dental
GHI
GHI employee
13551
claims
Montefiore
CMO
HIP and
CompreHealt
h EPO claims
for members 13174
managed by
Montefiore
CMO
Emdeon or
direct
submission
HIP Health
Plan of New
York
PO Box 2845
New York, NY
10116-2845
www.emblem
health.com or
1-866-447-97
17
Emdeon or
direct
submission
HIP Health
Plan of New
York
PO Box 2787
New York, NY
10116-2787
www.emblem
health.com or
1-866-447-97
17
Emdeon or
direct
submission EmblemHealt
h
PO Box 2845
New York, NY
10116-2845
www.emblemhe
alth.com or
1-866-447-971
7
Emdeon or
direct
submission
Vytra Health
Plans
Attn: Claims
Department
PO Box 9091
Melville, NY
11747-327
1-888-288-98
72
Direct
submission
www.emblem
health.com
or:
GHI/Emblem
Health
Dental Claims
PO Box 2838
New York, NY
10116
www.emblem
health.com or
1-212-615-4E
MC
Emdeon or
direct
submission
GHI Claims
PO Box 2861 www.emblem
New York, NY health.com
10116-2861
Web
MD/NEIC
CMO
200
Corporate
Drive
Yonkers, NY
10701
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1-877HIP-MONTE
(1-877-447-6
668)
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DIRECTORY
CLAIMS CONTACTS
Plans
Type of Claim
EDI or Payor ID
HealthCare
Partners
(HCP)
HIP and
CompreHealt
h EPO claims
11328
for members
managed by
HCP
Palladian
Muscular
Skeletal
Health
HIP
professional
claims for
PT/OT
services
members
managed by
37268
Palladian and
claims
billable under
the
Chiropractic
program
CareCore
National, LLC
HIP and GHI
claims
billable as
part of the
Radiology
program
14182
Clearing House
Submission
Address
Contact for
Inquiries
Web
MD/Envoy
HealthCare
Partners
Attn: Claims
Department
501 Franklin
Avenue
Suite 300
Garden City,
NY
11530-5807
1-516-746-22
00 or
1-888-746-22
00
Emdeon
Palladian
Health
www.palladia
PO Box 270
nhealth.com
Lancaster, NY
14086
Emdeon/Rela
y Health
CareCore
National LLC
PO Box
61022
Anaheim, CA
92803
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1-800-918-89
24 or fax:
1-843-815-65
79
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DIRECTORY
CLINICAL PHARMACY SERVICES (PRACTITIONERS)
CLINICAL PHARMACY SERVICES (PRACTITIONERS)
EmblemHealth (all plans managed by EmblemHealth with the exception of City of New York)
1-877-362-5670, Monday through Friday, 8 am to 6 pm
EmblemHealth (City of New York plans)
1-888-447-8175, Monday through Friday, 8 am to 6 pm
Express Scripts, Inc. (ESI) (home delivery for all plan members except for state and federal employees and
retirees with GHI coverage)
1-877-866-5798 (all commercial members with the exception of City of New York)
1-877-534-3682 (City of New York commercial members)
1-800-585-5786 (City of New York Medicare members)
1-877-866-5828 (EmblemHealth Medicare HMO/PPO members)
1-877-866-4165 (EmblemHealth Medicaid members)
1-800-899-2114 (for users of TDD/TTY)
24 hours a day, 7 days a week
Pharmacy Specialty Program
1-888-447-0295, Monday through Friday, 9 am to 5 pm
ICORE
1-866-554-2673, Monday through Friday, 8 am to 7 pm
RETAIL PHARMACY SERVICES (PHARMACIES)
RETAIL PHARMACY SERVICES (PHARMACIES)
HIP
1-800-992-6227, Monday through Friday, 8:30 am to 6 pm
GHI and GHI HMO
1-877-444-3786, Monday through Friday, 8:30 am to 6 pm
CompreHealth EPO
1-877-362-5670, Monday through Friday, 8:30 am to 6 pm
EmblemHealth EPO/PPO
1-877-793-6253, Monday through Friday, 8:30 am to 6 pm
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EmblemHealth Provider Manual
Last Updated: 09/03/2014
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DIRECTORY
BEHAVIORAL HEALTH SERVICES (PRACTITIONERS AND
MEMBERS)
BEHAVIORAL HEALTH SERVICES
(PRACTITIONERS AND MEMBERS)
Emblem Behavioral Health Services Program
(For members in plans underwritten by GHI HMO, HIP and HIPIC and administered by
VHMS)
1-888-447-2526
Monday through Friday, 9 am to 5 pm and 24 hours, 7 days a week for emergencies
Providers: Press 2 then choose from the following options:
1. If you do not need prior approval and are looking for eligibility, benefits or claims inquiries
2. To obtain information about your new or existing provider contract, credentialing or general plan policies or
procedures
3. for inpatient treatment, partial hospitalization and ambulatory detox prior approval
4. for outpatient treatment
5. for all other mental health questions
Montefiore
(For members in plans underwritten by HIP and administered by Montefiore)
1-800-401-4822
EmblemHealth Behavioral Management Program
(For members in plans underwritten by GHI)
1-800-692-2489
Monday through Friday, 8 am to 6 pm and 24 hours, 7 days a week for emergencies
Providers: Press 1 then 5 and choose from the following options:
1.
2.
3.
4.
5.
6.
7.
To check eligibility
To check benefits
To have a form faxed to you
For authorization of outpatient services
To review for inpatient or an alternative level of care
To inquire about the status of your appeal or to schedule an appeal
To check the status of your contract or credentialing/ recredentialing application or to update your
demographic information
8. To hear the mailing address for outpatient treatment reports or claims
EmblemHealth Depression Disease Management Program
1-800-447-0769
HOW TO OBTAIN PRIOR APPROVAL
HOW TO OBTAIN PRIOR APPROVAL
Plan/Managing Entity
Instructions
Submit prior approval request after signing
on to www.emblemhealth.com.
Call IVR system at 1-866-447-9717
CompreHealth EPO, HIP and Medicare HMO
Fax your request to 1-866-426-1509 for DME
or 1-866-215-2928 for all other requests.
To speak to a representative of the
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DIRECTORY
HOW TO OBTAIN PRIOR APPROVAL
Plan/Managing Entity
Instructions
EmblemHealth Prior Authorization
Department, call 1-866-447-9717.
Specialists, facilities and ancillary providers
must verify that prior approval has been
issued by signing on to the secure provider
Web site at www.emblemhealth.com,
checking in the IVR system at
1-866-447-9717 or by reviewing the
Concurrent Review Status Report (for
hospitals and skilled nursing facilities).
EmblemHealth EPO/PPO
Submit the prior approval request by signing
on to www.emblemhealth.com.
Fax the Prior Authorization request to
1-212-563-8391.
Call 1-212-615-4662 in New York City or
1-800-223-9870 outside New York City.
For questions regarding the status of a
request submitted, or questions regarding the
authorization process, you may call Customer
Service at 1-845-340-2300 or toll free at
1-877-244-4466.
GHI HMO and Medicare PPO
Submit the prior approval request by signing
on to www.emblemhealth.com.
Fax the Prior Authorization request to GHI
HMO at 1-877-508-2643.
Or mail your request to:
EmblemHealth
Utilization Management
55 Water Street, 12th Floor
New York, NY 10041
Urgent or expedited prior approval requests
required after business hours (which are
Monday - Friday, 8:30 am - 5 pm) should be
made by calling 1-877-244-4466. For
Medicare PPO, call 1-866-557-7300.
For questions regarding the status of a
request submitted or the authorization
process, call Customer Service at
1-845-340-2300 or toll free at
1-877-244-4466.
(See Additional Prior Approval Procedures
for GHI EPO/PPO and GHI HMO
Practitioners for more information.)
GHI EPO and GHI PPO
Submit the prior approval request by signing
on to www.emblemhealth.com.
Call the Coordinated Care Intake department
at 1-800-223-9870.
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Last Updated: 09/03/2014
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DIRECTORY
HOW TO OBTAIN PRIOR APPROVAL
Plan/Managing Entity
Instructions
(See Additional Prior Approval Procedures
for GHI EPO/PPO and GHI HMO
Practitioners for more information.)
Health Care Partners
Call 1-800-877-7587.
Or, fax your request to 1-888-746-6433.
Montefiore CMO
Call 1-888-666-8326.
For behavioral health services, call
1-800-401-4822.
Vytra Health Plan
Call 1-888-288-9872.
Prior approval requirements and procedures
may be different for Vytra ASO accounts, so
please contact the administrator listed on the
Vytra member's ID card for more
information.
Behavioral Health Services
Emblem Behavioral Health Services Program
(For members in plans underwritten by GHI
HMO, HIP and HIPIC and administered by
VHMS)
Call ValueOptions at 1-888-447-2526.
EmblemHealth Behavioral Management
Program (For members in plans underwritten Call ValueOptions at 1-800-692-2489.
by GHI)
Montefiore (For members in plans
underwritten by HIP and administered by
Montefiore)
Call 1-800-401-4822.
Cardiology and Radiology Services
Call:
CareCore National
Radiology
Cardiology
1-866-417-2345 (HIP and CompreHealth EPO)
1-800-835-7064 (GHI EPO/PPO, GHI HMO, and
EmblemHealth EPO/PPO)
Chiropractic Services
Send all requests to Palladian via the Web at
www.palladianhealth.com. Fax your request
to Palladian at:
1-716-712-2802 (HIP and CompreHealth EPO)
1-716-712-2803 (Vytra ASO)
1-716-712-2817 (GHI EPO/PPO and GHI HMO and
EmblemHealth EPO/PPO)
All EmblemHealth plans
You may also call 1-877-774-7693.
Outpatient Physical and Occupational Therapy
GHI HMO and HIP fee-for-service plans
Send all requests to Palladian via the Web at
www.palladianhealth.com. Or, your may fax
your request to Palladian at 1-716-809-8324.
You may also call 1-877-774-7693.
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EmblemHealth Provider Manual
Last Updated: 09/03/2014
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DIRECTORY
LABORATORY SERVICES
LABORATORY SERVICES
Although we maintain a contract with Quest Diagnostics Inc. to provide outpatient clinical
services to our members, other laboratories are also available for specialty tests.
A list of our network laboratories can be found at www.emblemhealth.com/~/media/Files
/PDF/Providers/EH_Network_Laboratory_Services.pdf.
Quest Diagnostics
Quest Diagnostics Patient Services Locator:
Quest Diagnostics Customer Service
department:
Quest Diagnostics Web site:
1-800-377-7220
1-800-631-1390
www.questdiagnostics.com
Contracted laboratories will provide a collection box and courier service to and from the
practitioner's office for specimen collection. If specimens need to be drawn outside of the
practitioner's office, members should be directed to the nearest contracted laboratory Patient
Service Center and given the requisition form to hand carry.
STAT Laboratory Services
Selected tests are available on a STAT (emergency) basis. Specimens requiring STAT services
should not be given to your routine Route Service Representative. Instead, practitioners should
call the Quest Diagnostics Logistics department for STAT specimen pick-up at the number
listed below. Practitioners may also consult their local Quest Diagnostics laboratory for more
information.
STAT results are reported by telephone as soon as available. Written and/or electronic reports
will follow per your routine medical report delivery system.
Please contact your local Quest Diagnostics laboratory to request a STAT service or pick-up.
New York (excluding Long Island): Logistics department: 1-800-223-0570
Long Island (Nassau and Suffolk Counties): Logistics department: 1-800-877-7588
New Jersey: STAT laboratory direct number: 1-800-648-4738
URGENT CARE CENTERS
For urgent conditions that do not meet the layperson's definition of an emergency, all
EmblemHealth plan members have access to network urgent care centers.
To find a list of network urgent care centers, use the Find a Doctor tool on our website at
www.emblemhealth.com/find-a-doctor. You may also call Member Customer Service to obtain
this information.
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DIRECTORY
Vytra plan members should visit www.vytra.com or call Vytra's Customer Service line at
1-866-409-0999.
For more information on urgent care centers, please visit the Urgent Care Centers section of
the Care Management chapter.
COMPLAINTS, GRIEVANCES, AND APPEALS
(PRACTITIONERS AND MEMBERS)
For process terminology, filing instructions and applicable time frames for disputing
determinations that result in a denial of payment and/or covered services, please go to the
following chapters:
Dispute Resolution - Commercial/Child Health Plus
Dispute Resolution - Medicaid/Family Health Plus
Dispute Resolution - Medicare
ADDITIONAL RESOURCES (PROVIDERS AND MEMBERS)
ADDITIONAL RESOURCES (PROVIDERS AND MEMBERS)
Entity
Address
Phone
E-mail/Comments
2732 Transit Road
West Seneca, NY
14224
1-877-774-7693
www.palladianhealth.
com
Delegated for
utilization
management.
7400 Gaylord
Parkway
Frisco, NY 75034
Provider Relations:
1-800-290-0523
Member Services:
1-877-548-4447
www.careington.com
Delegated for
credentialing.
333 Earle Ovington
Blvd.
Ste 300
Uniondale, NY
11553-3608
General Line:
1-516-794-3000
Provider Relations &
Medical
Management:
1-516-542-2600
Claims:
1-888-468-2183
Member Services:
1-800-468-9868
www.healthplex.com
Delegated for
credentialing,
utilization
management and
claims processing.
501 Franklin Ave.
Suite 300
Garden City, NY
General Line:
1-800-877-7587
Customer Service:
Delegated for
credentialing,
utilization
Chiropractic and Physical/Occupational Therapy
Palladian
Muscular Skeletal
Health
Dental Services
Careington
International Corp.
(For HIP Preventive
Dental)
Healthplex
(For HIP State
Sponsored Programs
and HIP Prime Dental
Claims)
Managing Entities
HealthCare
Partners (HCP)
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DIRECTORY
ADDITIONAL RESOURCES (PROVIDERS AND MEMBERS)
Entity
Address
Phone
E-mail/Comments
11530-5807
(Providers and
Members):
1-516-746-2200 or
1-888-746-2200
management, claims
processing and first
call resolution.
100 Corporate Drive
Yonkers, NY 10701
1-877-HIP-MONTE
( 1-877-447-6668 )
Delegated for
credentialing,
utilization
management and
claims processing.
PO Box 61022
Anaheim, CA 92803
General line:
1-800-918-8924
Customer Service
(Providers):
1-800-918-8924 ext
11879 (phone)
1-843-815-6579 (fax)
Davis Vision
(For GHI members
only)
159 Express St.
Plainview, NY 11803
1-800-999-5431
Delegated for
credentialing and
claims processing
Comprehensive
Professional
Systems
(For HIP members
only)
11 Hanover Square
New York, NY 10005
1-212-675-5745
EmblemHealth
conducts claims
processing
Eye Care
Advantage
(For HIP members
only)
1953 Grand Avenue
Baldwin, NY 11510
1-516-623-3700
EmblemHealth
conducts claims
processing
General Vision
(For HIP members
only)
520 Eighth Avenue
New York, NY 10018
1-800-847-4661
EmblemHealth
conducts claims
processing
5850 T.G. Lee Blvd.,
Suite 510
Orlando, FL 32822
1-800-424-4088
Delegated for
utilization
management.
Montefiore CMO
Radiology Services
CareCore National,
LLC
Vision Services
Medical Injectables
ICORE National, LLC
SELECTED RESOURCES FOR MEMBERS WITH SPECIAL
NEEDS
Sign Language Interpreter Services of the Speech and Hearing Impaired
Plan providers (or members or their representatives) can contact the Customer Service
Department via phone at 1-646-447-6534 or TeleTypewriter (TTY) at 1-800-874-9426 to
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DIRECTORY
request a sign language interpreter for a provider appointment.
If the member calls, s/he will be asked to have the provider contact EmblemHealth to arrange
for the interpreter. If the member is communicating through one of EmblemHealth's TTY
devices, the Interview Unit can contact the provider while the member is "holding" to verify the
appointment. The Interview Unit will contact the member to confirm the interpreter
arrangements. We primarily arrange these services through F•E•G•S.
F•E•G•S Health and Human Services System
www.fegs.org
F•E•G•S/NYSD Services Counseling Center
The Harry and Jeanette Weinberg Health Related and Human Services Center
80 Vandam St.
Second Floor
New York, NY 10013
Phone/TTY: 1-212-366-0066
F•E•G•S., a not-for-profit organization, provides comprehensive social and rehabilitative
services for people who are deaf or deaf-blind and reside in the New York metropolitan area.
The staff of F•E•G•S is able to communicate directly with its constituency through the
use of sign language, tactile communication, lip reading, or any other form of communication
in which the consumer feels most comfortable. F•E•G•S's Interpreter Referral Services
provides skilled interpreters throughout the New York City metropolitan area in a wide range
of settings.
SERVICES FOR THE VISUALLY IMPAIRED
Lighthouse International
www.lighthouse.org
Lighthouse International is a leading worldwide resource on vision impairment and vision
rehabilitation. Through its work in vision rehabilitation services, education, research and
advocacy, Lighthouse International enables people of all ages who are blind or partially sighted
to lead independent and productive lives.
New York City Headquarters
111 East 59th St.
New York, NY 10022-1202
Westchester County Regional Office
170 Hamilton Ave.
White Plains, NY 10601
RESOURCES FOR CHILDREN WITH SPECIAL NEEDS
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DIRECTORY
Early Intervention Program (EIP)
New York State law requires that all primary referral sources (e.g., primary care physicians
(PCPs), specialists, hospitals, etc.) shall, within two working days of identifying a child under 3
years of age with either a risk factor for developmental delay or an actual developmental delay
or disability, refer that child to the Local Early Intervention Agency (LEIA) corresponding to the
child's county of residence. In most cases, the LEIA is the County Department of Health.
Parental consent is required for referral. The EIP has two components:
The Infant Child Health Assessment Program (ICHAP) serves as the "child find" component.
Only children with a risk factor for developmental delay should be referred to this
component. Referred children are tracked to insure that their pediatricians/PCPs conduct
periodic developmental assessments and if such assessments indicate developmental delay,
the program facilitates referrals to the EIP component.
The Early Intervention Program (EIP) provides for evaluation and developmental services
when a child has or is suspected of having a developmental delay. Services are provided by the
LEIA's network of approved EIP providers. The LEIA is under no obligation to use providers in
the child's health plan network. When the services rendered are covered by a third party, the
LEIA is authorized to bill the third party on behalf of the servicing provider.
For information please call the New York State Growing Up Healthy Hotline at
1-800-522-5006. You may also call the LEIAs at:
New York City: 1-800-577-BABY (1-800-577-2229) or 1-212-219-5213
Nassau County: 1-516-227-8661
Suffolk County: 1-631-853-3100
Westchester County: 1-914-813-5094
Orange County: 1-845-291-2333
Rockland County: 1-845-364-2625
Preschool Supportive Health Services Program (PSHSP)
When children between 3 and 4 years of age are identified as having or are at risk of
developmental disability, pediatricians/PCPs shall, with parental consent, refer the children to
the Committee on Special Preschool Education serving the school district in which the children
reside. This program ensures that such children are evaluated and receive needed special
education and that disability-related health services are provided by PSHSP providers
approved by the Committee on Preschool Special Education. The program is under no
obligation to use providers in the child's health plan network. The school district bills the state
for services rendered to Medicaid managed care members. When the services rendered to
non-Medicaid members are covered by a third party, the school district is authorized to bill the
third party on behalf of the servicing provider.
School Supportive Health Services Program (SSHSP)
When children between 5 and 21 years of age are identified as at risk for or having a
developmental disability, pediatricians/PCPs shall, with parental consent, refer the children to
the Committee on Special Education serving the school district in which the children reside.
This program ensures that such children are evaluated and receive needed special education
and that disability-related health services are provided by SSHSP providers approved by the
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Committee on Special Education. The program is under no obligation to use providers in the
child's health plan network. The school district bills the state for services rendered to Medicaid
managed care members. When the services rendered to non-Medicaid members are covered by
a third party, the school district is authorized to bill the third party on behalf of the servicing
provider.
Physically Handicapped Children's Program (PHCP)
PHCP provides financial assistance for medical care and support services to children that have
severe, long-term health problems and chronic disabilities. Eligible conditions include birth
defects, physical handicaps and other conditions that can be improved with treatment and
early intervention.
PHCP has two components: the Diagnosis and Evaluation Program and the Treatment
Program. Diagnostic services are available to all children who are believed to have physically
disabling conditions or serious chronic illnesses. To receive diagnostic services, families do not
have to satisfy local financial eligibility criteria, but prior authorization from the local PHCP
must be obtained. Diagnostic services are provided through approved specialty centers or
medical specialists. If the child is covered by health insurance or Medicaid, these funding
sources must be billed first. If the child has neither insurance nor Medicaid, then the authorized
services are paid for directly by the PHCP.
The treatment component reimburses health care providers for services rendered to eligible
children. Inpatient hospital care, physician office visits, durable medical equipment and
pharmaceuticals are examples of items covered by the program. PHCP will cover the cost of
medically needed care and supplies not covered by some health insurance plans, such as over
the counter drugs/supplies and transportation.
Application for the Treatment Program must be made to the county in which the child resides.
There are some variations between counties for conditions covered and financial eligibility. Financial criteria are designed to assist families with low incomes or inadequate private health
insurance. All services provided under PHCP must have prior authorization from the county
health department.
For more information, please call the New York State Growing Up Healthy Hotline at
1-800-522-5006 or:
New York City: 1-212-676-2950
Nassau County: 1-516-571-0801
Suffolk County: 1-631-853-2286
Westchester County: 1-914-813-5328
Orange County: 1-845-568-5280
Rockland County: 1-845-364-2081
CUSTOMER SERVICE (FOR MEMBERS)
CUSTOMER SERVICE (FOR MEMBERS)
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DIRECTORY
EmblemHealth
1-877-842-3625, seven days a week (excluding major holidays), 8 am to 8 pm
TTY/TDD: 711
EmblemHealth Medicare HMO
1-877-344-7364, seven days a week (excluding major holidays), 8 am to 8 pm
TTY/TDD: 711
EmblemHealth Medicare PPO
1-866-557-7300, seven days a week (excluding major holidays), 8 am to 8 pm
TTY/TDD: 711
GHI EPO/PPO
1-800-624-2414, seven days a week (excluding major holidays), 8 am to 8 pm
Also NYC: 1-212-501-4444
TTY/TDD: 711
GHI HMO
1-877-244-4466, seven days a week (excluding major holidays), 8 am to 8 pm
TTY/TDD: 711
HIP and HIPIC
1-800-447-8255, seven days a week (excluding major holidays), 8 am to 8 pm
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DIRECTORY
PHARMACY SERVICES (FOR MEMBERS)
PHARMACY SERVICES (FOR MEMBERS)
EmblemHealth
(for all EmblemHealth, GHI and HIP members excluding GHI retirees and city, state and
federal employees with GHI coverage)
1-877-444-3614, Monday through Friday, 8:30 am to 6 pm
TTY/TDD: 711
Medicare PPO Prescription Drug Plan
(for Medicare PPO members excluding retirees and city, state and federal employees)
1-877-444-7241, 7 days a week, 8 am to 8 pm
TTY/TDD: 711
Medicare PPO Pharmacy Line
(for providers and Medicare members excluding retirees and city, state and federal
employees)
1-866-557-7300, Monday through Friday, 8 am to 8 pm
TTY/TDD: 711
Medicare HMO Pharmacy Line
(for providers and Medicare members excluding retirees and city, state and federal
employees)
1-800-447-8255, Monday through Friday, 8 am to 8 pm
TTY/TDD: 711
GHI Customer Service
(for GHI retirees and city, state and federal employees)
1-800-624-2414, Monday through Friday, 8 am to 5 pm
If calling from New York City, members may also call 1-212-615-4444
TTY/TDD: 711
Express Scripts, Inc. (ESI)
(home delivery)
1-877-534-3682 (GHI City of NY group members)
1-877-866-5798 (Commercial members)
1-877-866-5828 (EmblemHealth Medicare HMO/PPO members)
1-877-866-4165 (HIP Medicaid members)
711 (TTY/TDD users)
24 hours a day, 7 days a week
Physicians may call 1-800-305-5287 for instructions on how to fax a prescription to ESI. In
addition, members can speak to a registered pharmacist for medication counseling.
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