No More Claim Payments from Emblem

EmblemHealth will not entertain any Medicaid, HARP and Child Health Plus Claims from providers who are not enrolled in the New York State Medicaid Fee-For-Service program. This will come into action from September 1, 2022.

All Medicaid Managed Care (MMC) networks’ furnishing, ordering, prescribing, and referring providers to be enrolled with State Medicaid programs as stated in section 5005(b)(2) of the 21st Century Cures Act. The NYS Medicaid Program adopted this enrollment requirement. 

EmblemHealth will deny claims submitted by providers who are not enrolled or in a pending enrollment status with the NYS Medicaid Program as a billing provider or as an Order/Prescribe/Refer/Attend (OPRA).