Some of our plans also include hearing aid allowance benefit. You must obtain your hearing aids from a NationsHearing provider. The allowance is applied at the time of your purchase — there are no reimbursement requests needed. Members can speak one-on-one with a registered nurse, at any time.
Nurses are trained in telephone triage and will provide clinical support for everyday health issues and questions, if you have non-emergency health and medical questions. Your call is confidential.
There is no cost to you to call the nurse hotline: TTY: Remember, if you have an emergency, call or use your local emergency number. If not currently enrolled call Medicare members call TTY: 8 a. You are now leaving the Medicare section of the website. You are now leaving. Please check the Privacy Statement of the website to which you are going. Any information provided on this Website is for informational purposes only.
It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.
Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.
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Find Care Find a doctor, dentist, specialty service, hospital, lab, and more. Member Sign In Welcome to the ConnectiCare member portal, where you can find doctors, compare costs, and view claims. Sign In. Our Plans. We've Got You Covered Our plans are designed to provide you with personalized health care at prices you can afford. Get a Quote. Member Resources. Live Well. Guidance on the Baby Formula Shortage As the baby formula shortage continues, there are certain precautions you should take.
Sign up For DC 37 News. Blog Events. Facebook Twitter YouTube Instagram. Latest News. Engage and empower our union! To volunteer in Community Outreach programs, click here. Using Direct Reimbursement You may obtain a direct reimbursement form from the Plan office or you may click here to download this form. Maximizing Your Optical Benefit In order to maximize the optical benefit, the member must obtain and file for all three services—eye examination, lenses and frames—simultaneously on the same claim form, whether using the voucher or direct reimbursement method.
A voucher can be used for exam, frames and lenses. For cataract contact lenses, the reimbursement method should be used. If the voucher has been lost, destroyed, or never received, the member should call the Plan office and request a notary letter.
Once the notary letter is completed by the member and returned to the Plan office, a new voucher will be issued. If the voucher is outdated, the voucher MUST be returned to the Plan office indicating if the voucher is to be voided only, or voided and reissued.
When you start therapy with an EmblemHealth in-network therapist, they will designate a diagnosis for your condition or goals. This is essential for coverage of your therapy sessions. This way, your mental health care stays between you and your therapist — not the insurance company and anyone who has access to your insurance account information. EmblemHealth covers many different evidence-based therapy approaches and modalities.
This includes but is not limited to:. In order to provide coverage for treatment, EmblemHealth requires that therapists provide diagnosis-based therapy appropriate for the mental health diagnosis. Many therapists blend their approaches while meeting with clients. As long as the therapist meets all of the EmblemHealth requirements, they are eligible for reimbursement.
If a therapy approach is not evidence-based — that is, has empirical research backing its efficacy — EmblemHealth will not cover therapy costs. This includes life coaching and career coaching, as these disciplines are less based on the mental health literature and more on goal-setting and achievement.
EmblemHealth does not cover holistic approaches to treatment such as aromatherapy, massage therapy, or nutritional therapy.
They also do not cover hypnosis, ketamine, and psychedelic treatments, even if the purpose of this treatment is for a mental health condition. Yes, EmblemHealth covers online therapy. As more therapists offer both in-person and online options, EmblemHealth recognizes the importance of accessible mental health treatment. While EmblemHealth may require the therapist to follow certain policies — such as using a secure video platform — clients can see their in-network therapists online instead of in the office without a change in their cost.
Some EmblemHealth plans offer coverage for couples counseling , but not all of them. However, some plans do have couples counseling as a benefit, and there are also many ways to make couples sessions more affordable. This opens the door for you and your partner or partners to work with a high-quality couples therapist and grow your relationships.
Depending on your EmblemHealth health insurance plan, you may need to receive a referral from your primary care physician before you begin seeing your therapist. For all EmblemHealth plans that are HMO, you will need to visit your primary care physician and share your interest in mental healthcare. This is a quick and common process that should not be a major roadblock in your therapy journey! Health Insurances Emblem Health for Therapy. Emblem Health for Therapy EmblemHealth is a large health insurance company that insures over 3 million residents of the East Coast.
Does EmblemHealth cover therapy? How do I check if my EmblemHealth plan covers therapy? How much does therapy cost with the EmblemHealth plan? Please see the required fields listed above. If billing on paper, inpatient services and alternate levels of care e. If the provider submits a clean claim electronically within timely filing limits, compensation to the provider shall be at the rates specified in the fee schedule and paid to the provider within 30 days for electronic claim submission and 45 days for claims submitted on paper.
Payformance is a vendor that partners with Beacon Health Options to deliver an electronic funds transfer EFT solution to our providers. PaySpan Health is a multi-payer adjudicated claims settlement service that delivers electronic payments and electronic remittance advices based on your provider preferences. With PaySpan Health, you stay in control of bank accounts, file formats, and accounting processes. What is the unique registration code number that PaySpan Health requests and how do I obtain it?
Your unique registration code is the registration number that Beacon Health Options supplies to providers for enrolling in PaySpan Health. If you do not have the letter with your unique registration code, please send an e-mail to CorporateFinance beaconhealthoptions.
You will receive an e-mail with your registration code letter within three business days of your request. Note: If you recently received a payment from Beacon Health Options, your unique registration code will be located on the check stub after the marketing caption. Licensed clinicians are available 24 hours a day, 7 days a week and days a year. As an inpatient facility, when should an authorization of an admission be requested?
Pre-certification is required for all elective inpatient services. Our phone lines are open 24 hours a day, 7 days a week and days a year. Prior approval is not required for routine outpatient services. Outpatient Services: Beacon Health Options is responsible for adjudicating claims for dates of service on or after the start date of the program.
Inpatient Services: Beacon Health Options is responsible for adjudicating claims for inpatient dates of service when a member is admitted to an inpatient unit on or after the start date of the program. Who is responsible for members admitted to an inpatient medical unit who also have behavioral health issues that need to be treated? Members admitted to a medical floor are the responsibility of EmblemHealth.
Authorization is required by EmblemHealth Prior Authorization department and claims must be submitted to EmblemHealth. If the member is transferred to a psychiatric or substance abuse unit except for medical detoxification , Beacon Health Options will need to review, authorize the care, and process the claims. Claims for dates of service in the psychiatric or substance abuse unit should be submitted to Beacon Health Options.
For members seeing Beacon Health Options providers, nothing is required. Beacon Health Options manages outpatient care via outlier management review. Beacon Health Options will notify you if a treatment plan is required. Beacon Health Options utilizes Availity Essentials verifying eligibility and benefits, claim status and other secure transactions. If you have technical questions specific to Availity Essentials, please contact Availity Client Services at , 8 a.
If, however, a paper claim needs to be sent in such as for a corrected claim , please send it to:. Please visit us online at www. Mobile Site Search Search Field. Facebook Twitter LinkedIn. As a reminder, please ensure that you have completed your required Cultural Competency training. If you are a Practitioner, please visit CAQH, update your information, and attest that it is accurate. Provider Groups and Facilities may visit our provider portal or call our National Provider Service Line at to share your individual provider information.
Which EmblemHealth members are not affected by the transition? The transition to Beacon Health Options does not apply to members who: Do not have a behavioral health benefit Members who have the Montefiore logo on the lower left corner of their ID cards and are being treated by a provider in the Montefiore network are not required to change providers.
They also have the option to use Beacon Health Options network providers. How does this impact me? How does the transition affect my contract with Magellan Health Services?
How does the transition affect my contract with HIP? Will members receive new ID cards or ID numbers? All other ID cards: New ID cards will be issued to all other plan members as groups renew throughout the year.
The Emblem Behavioral Health Services Program Customer Service phone number will not change on the cards, but the name of the program and claims address will be updated on reissued ID cards. ID numbers: There will be no change to any member ID numbers. What do I have to do? Do I have to be credentialed by Beacon Health Options?
Availity Essentials Effective March 1, , Availity Essentials is the preferred portal for verifying eligibility and benefits, claim status and other secure transactions for Beacon Health Options. What paper forms can be used for claims submission? Auto accident? Other accident? As a facility, how do I bill professional services? As a facility, how do I bill nonprofessional services? What are Payformance and PaySpan Health? What are the prior approval requirements for outpatient services?
What is the process for continuing outpatient care? Where do I submit my claims prior to the effective date of the transition?
Lastly, EmblemHealth has sent correspondence to all its participating providers amending their contracts to meet current New York State regulatory and compliance standards. The expanded relationship with Beacon Health Options will not impact this program. Members who have the Montefiore logo in the lower left corner of their ID card, whether in treatment or not, will continue to access behavioral health providers in the Montefiore network. These members also may, at their option, utilize the Beacon Health Options network.
Please note that utilization management functions for behavioral health services for these members, including prior approval, will continue to be performed by Montefiore. If a patient chooses to remain under the care of a non-participating provider after the transitional day period, services will not be covered as in-network and your patient may be responsible for all or a portion of your charges, depending on the plan. Please contact Magellan directly at to discuss your contract with them. Once the transition occurs, your contract with HIP will become dormant.
Once the transition date is effective, EmblemHealth will no longer be contracting directly with behavioral health providers. Please follow the instructions provided in the correspondence and return any required documents within 10 business days of receipt. I do not participate in any of the Beacon Health Options networks. How do I join? To ensure member access to treatment and to minimize potential care disruption, Beacon Health Options has extended invitations for network participation.
We encourage you to adhere to the instructions and processing time frames that were outlined in the letter. The fee schedules were enclosed in the invitation to join the Beacon Health Options network. The fee schedules detail the payments by CPT code and licensure that you will receive for providing services to the EmblemHealth membership.
If you are already participating in Beacon Health Options Commercial network, you should have received a letter extending network participation for the Emblem Behavioral Health Services Program administered by Beacon Health Options Program.
My current Outpatient fee schedule is more favorable than Beacon Health Options. With whom do I discuss the fee schedule? Beacon Health Options fee schedules for outpatient services are reviewed routinely and at present are determined to be competitive with that of other companies with similar HMO business across the United States.
In general, the fee schedules for outpatient services are non-negotiable. If you have any questions, please contact the Provider Service Line at and ask to speak with a Provider Service Representative. Beacon Health Options reimbursement schedules for inpatient services have been determined to be competitive with other companies with similar HMO business across the United States. In general, the inpatient reimbursement schedules are non-negotiable.
If you believe that your fee schedule needs to be reviewed, please contact our Contracting Department at and request to speak with a Contract Development Director. For issues not related to your fee schedule, please contact the Provider Service Line at and ask to speak with a Provider Service Representative. Yes, all non-participating providers must be credentialed by Beacon Health Options in order to participate in the Beacon Health Options network. Would Beacon Health Options accept the materials I have just submitted to EmblemHealth rather that my completing a new application?
Unfortunately, no. As an NCQA accredited organization, Beacon Health Options requires specific information and all providers must be credentialed by us in order to be considered as an in-network provider.
Beacon Health Options has online services to provide added convenience for our members and providers. Effective March 1, , Availity Essentials is the preferred portal for verifying eligibility and benefits, claim status and other secure transactions for Beacon Health Options. If you have technical questions specific to Availity, please contact Availity Client Services at , 8 a. ET, Monday through Friday.
You can find more information about ProviderConnect on www. Yes, Beacon Health Options encourages electronic submission. If you are interested in electronic claim submission, please contact our Beacon Health Options Electronic Claims Specialist at We strongly encourage providers to submit claims electronically for the efficiencies gained by both providers and in claims processing.
Red ink forms should be used as these can be scanned, which expedites the claim entry into the claims system. The UB Form can only be used for inpatient and alternative levels of care for mental health and substance abuse, not outpatient professional mental health services.
The CMS form should be used for outpatient professional services. Does the Beacon Health Options electronic claims format work with other claims clearing houses? All submitters, providers and clearing houses, must be registered to submit claims electronically. If you utilize the services of a third party vendor, please ask them if they are registered.
Please note: Beacon Health Options does not reimburse for provider expenses associated with electronic claims submission. Beacon Health Options. For any other electronic claims submission questions, please contact our Beacon Health Options Electronic Claims Specialist at When Beacon Health Options authorizes care, is the authorization an automatic guarantee of payment for services rendered? No, authorization of services is not a guarantee of payment. Payment depends on a number of factors including member eligibility, provider contract status, and benefit limits at the time care is rendered and the claim is processed.
As an individual practitioner billing outpatient services, do I need to include the provider number on my claims? We strongly recommend billing electronically, either via EDI or our web-based direct claim submission.
Please note: Billed lines are limited to 10 per claim form. In addition, please visit www. Outpatient professional services must be billed on a CMS form. Please see the required fields listed above. If billing on paper, inpatient services and alternate levels of care e. It is not medical advice and should not be substituted for regular consultation with your health care provider.
If you have any concerns about your health, please contact your health care provider's office. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. Switch to: members brokers employers. Sign in Contact Us Search. Navigation Open. Switch to:.
Clinical Corner. Quality Improvement Find our Quality Improvement programs and resources here. Search Our Quality Improvement Page. Claims Corner. Reimbursement Policies Payment processes unique to our health plans Payment Integrity Policies How we pursue payment accuracy.
Onychomycosis Testing (LBM) Download (PDF) Operating Microscope/Microsurgery (CPT /) Download (PDF) Ophthalmology Reimbursement Policy. Download (PDF) Oral . Does EmblemHealth reimburse for AHIP? No, but we as your upline do. CLICK HERE to get your discounted AHIP. Questions about qualifications? Call or email . In order to provide coverage for treatment, EmblemHealth requires that therapists provide diagnosis-based therapy appropriate for the mental health diagnosis. Many therapists blend .