Provider Portal Frequently Asked Questions

Last Reviewed Date: 08/18/2021

Migration Preparation

To help with the transition, you will need to know:

  • All current User ID and password combinations.
  • Security Questions/Answers for each account.
  • Have an active, current, and unique email (one User ID per person – you can no longer share User IDs).
  • The assigned Provider Portal Administrator/Office Manager for your practice/organization. 

If you had a user account on our current portal and accessed the portal within the last 6 months, we migrated your access to the new portal. 

About the New Portals

EmblemHealth’s new Provider Portal will offer these new functions and features:

  • The time period for the availability of claims data is being expanded from 18 to 24 months.
  • The amount of data you will be able to download into a claims report is expanded to 10,000 records.
  • The Preauthorization Check tool will apply to all lines of business.
  • Providers will be able to conduct more Utilization Management transactions on the Provider Portal, including submission of inpatient and outpatient authorization, submission of Benefit Extensions, and ability to add attachments with authorization.
  • A more robust news feed to your home page to keep you up to date on plan news, and process and policy changes.
  • The bulk eligibility report feature has increased to 25 members and now provides the ability to download in an Excel format

ConnectiCare’s new Provider Portal will offer these new functions and features:

  • A new Message Center, including secure messaging and the ability to submit attachments.
  • The ability to create, submit, and view preauthorizations online.
  • The ability to create a bulk eligibility report and to download it in an Excel format.
  • Expansion of the predefined user roles and permissions to align with user’s job functions, which will give more access options – it’s currently just two roles (administrator, non-administrator).
  • Ability to see all preauthorization determinations in one place.

Account Migration

Yes. If you have bookmarked our Provider Portal pages, the bookmarks may not work. To get to the new sites, we recommend that you delete your existing bookmarks and access our sites using the “Sign In” links on our public websites for providers.

For EmblemHealth, go to: emblemhealth.com/providers/resources/provider-sign-in

For ConnectiCare, go to: provider.connecticare.com/

You should make sure you’re using a supported browser such as Google Chrome or Microsoft Edge. We are recommending Google Chrome for the best user experience. The new site cannot be used with Internet Explorer.

Yes. The new portal has the last 30 days of reports available to you.

Yes. All messages going back to July 2020 have been migrated, but they may be displayed a bit differently. You may want to make note of the “Inquiry Date” of any critical messages to help you find them. Attachments to those messages are not accessible on the new portal. If an attachment is needed, the Provider Customer Service team will be able to obtain a copy for you. 

A maximum of 200 messages will be shown at a time in order of the date created.

No. You will not be able to go back into the old Provider Portal(s).

Multi-factor authentication is an industry-standard safety mechanism used to confirm that secure websites are being accessed only by a rightful and authorized user.
 

To accomplish this, our new Provider Portals require a secondary method – a unique email address – to validate the user’s identity. 
 

We use the email address on the user account to send out a verification code that needs to be entered after the sign-in to proceed with accessing the system. 
 

This account validation will be triggered every three months or if we detect that you have switched computers or devices that you use to access the Provider Portal. 
 

This step should take only a few seconds and helps us significantly improve the security of our systems and the confidential information of the communities we serve.

Account Consolidation

If you needed to use different sign-in credentials on our current portals, you can consolidate your access under a single username, password (also referred to as PIN), and email address. This will allow you to view data across the different products and prevent you having to sign in and out, transferring between accounts. Consolidation, however, will not be automatic.
 

After creating the initial username, you will follow similar steps with each of your other accounts. If you provide the same email address each time, the process will let you consolidate access into a single user account that will work for both EmblemHealth’s and ConnectiCare’s Provider Portals. 
 

Please note: Your password and PIN are interchangeable.

Yes, but only until you consolidate them after the new site is live. After you create one account, you will have the ability to link all User IDs.

Yes. Once you consolidate the accounts, you will be able to use one account for both EmblemHealth and ConnectiCare. Access will be through one account, and you will no longer need to switch back and forth.

Training

We posted the following training materials for your use:

  • Micro-videos 
  • PowerPoint presentations
  • Quick Reference Guides (Job-Aids)

EmblemHealth Training materials

ConnectiCare Training materials

Training material covers a range of topics including:

  • The sign-in process
  • Portal navigation
  • How to set different user roles
  • Downloading reports to Excel
  • Managing patient care using referral and preauthorization transactions
  • Finding claims information, checking images, and Explanations of Payment (EOPs)
  • And much more

Please contact our Provider Customer Service, Monday to Friday from 8 am to 6 pm:

EmblemHealth: 866-447-9717
ConnectiCare Commercial: 860-674-5850 or 800-828-3407
ConnectiCare Medicare: 877-224-8230

Site Access

Joining Existing Group
If you have joined a practice, group, or facility that already has a relationship with our companies, you will be able to reach out to your Portal Administrator or Office Manager to set up access to the Provider Portal. 
 

If you do not know your Portal Administrator or Office Manager, please contact Provider Customer Service, Monday to Friday from 8 am to 6 pm for assistance:
 

EmblemHealth: 866-447-9717
ConnectiCare Commercial: 860-674-5850 or 800-828-3407
ConnectiCare Medicare: 877-224-8230
 

Newly Contracted Provider
If you, your practice, facility, etc., have signed a brand-new contract with us, or have activated a new Tax ID, we will reach out to your designated Administrator. They will be sent a single registration code per Tax ID to unlock access for the affiliated providers and users. Your Administrator/Office Manager will then be able to set you up with access to our Provider Portal. The new portal does not allow bulk uploads of new Tax IDs or new users.
 

If you believe you should have received a communication but are unable to find it, please reach out to Provider Customer Service, Monday to Friday from 8 am to 6 pm, and one of our agents will be happy to help you with getting a new registration code to complete your Provider Portal access setup:
 

EmblemHealth: 866-447-9717
ConnectiCare Commercial: 860-674-5850 or 800-828-3407
ConnectiCare Medicare: 877-224-8230 

Usually the person who oversees the Patient Financial Services (PFS) workflow of PFS is responsible for being the key administrator – the person who maintains and obtains insurance web portal access and assigns rights to the portal. 
 

Ask your supervisor if you don’t know your Office Manager. If they do not know, please contact Provider Customer Service, Monday to Friday from 8 am to 6 pm for assistance:
 

EmblemHealth: 866-447-9717
ConnectiCare Commercial: 860-674-5850 or 800-828-3407
ConnectiCare Medicare: 877-224-8230

Your Office Manager for your organization can perform the following (but not limited to):

  • Create an account
  • Change an existing account’s access 
  • Update account permissions to create referrals or benefit extensions 

Type of access (role) is defined at the Tax ID level. Only one type of access may be assigned per user per Tax ID in the new portal. Different Tax IDs may have different types of access assigned to a single user. See:
 

EmblemHealth’s Role Permissions Table

ConnectiCare’s Role Permissions Table

Yes. Users can be provided access at the Tax ID level and have access to multiple Tax IDs. This should give full access to all claims and authorizations across all their participating providers.
 

While not recommended, if a single user does want separate accounts to differentiate their work across Tax IDs or to have more than one type of access for a Tax ID, they must use a unique email address for each account.

Yes. Only a single username is required to see all data – medical and dental.

User default timeout after inactivity is 15 minutes. A warning message will appear 30 seconds before the 15-minute mark and access to the site is ended.

Eligibility/Benefits

Benefit summaries are displayed on the portals and can be printed.

Yes. By going to “Eligibility” under the Member Management menu, you may see eligibility search results for the last two years.

When you look up a member, you will see the Coverage Start Date for the member. Typically, this will be early in the year (e.g., Jan. 1). Then the “Coverage End Date” is a default date that is something like “12/31/9999.”

The Coverage End Date is open-ended because we don’t know if/when a member will renew their policy, change jobs, stop paying their premium, etc. That is why their end date is always open.

Payment is always subject to a member’s eligibility on the applicable date(s) of service.

The portal is set up to conduct partial name searches; an exact match to a full name with a hyphen is not needed. A minimum of two characters has to be entered.

Member Management

The ID card displayed is the actual ID card and both the front and back are to be shown. When an actual ID card is not available, we will show a temporary ID card.

Managing Members – PCP Member Panel Report

Yes. You are able to run a PCP Member Panel Report by clicking on the Member Management tab in the menu and then the PCP Member Panel Report sub-menu. 
 

The report will only include active members.

Yes. You can run a report for each PCP you are affiliated with. Once on the PCP Member Panel Report page, you can search by a specific provider to generate their report.

Yes. You will be able to generate a PCP Member Panel Report that may be exported to Excel. 
 

Note that documents can take up to 30 minutes from when you select “Export to Excel” before appearing in the Documents tab.

Claims

Users will be able to search for claims submitted within the last two years. Search results, however, will only be displayed showing 90 days of information at a time. 
 

Explanation of Payment (EOP)*/remittance information will be available in the Claims Details page. If there is no remittance information available, then there will be a message stating there are no records found. 
 

Check images will be available for the past two years. 
 

V-cards are not available as separate images but will be part of the Explanation of Payment documents.
 

If information is needed for a prior time period or you can’t find what you need, you may submit a request through the Message Center using the Ask a Question option. You may also contact Customer Service at: 
 

EmblemHealth: 866-447-9717
ConnectiCare Commercial: 860-674-5850 or 800-828-3407
ConnectiCare Medicare: 877-224-8230
 

*Explanations of Benefits (EOBs) are documents sent to members. Providers are given Explanations of Payment (EOPs).

Yes. Claim results, including payment information, can be exported to Excel. After exporting the results, you can download the CSV file from the document center. The document will be available only for you.

Coordination of Benefits (COB) may be found in the Additional Insurance section of the Member Details Page returned on a member eligibility search.

Preauthorization

Yes. Existing preauthorization transactions are available in the new portals. Further, users are able to search for preauthorizations issued within the last two years. Search results, however, are only displayed showing 90 days of information at a time.

Yes. You can now use the Preauthorization Check Tool to check for authorization requirements across our membership.  
 

The Tool will indicate whether preauthorization is needed and from whom. The tool should not be used to determine benefit coverage. The tool does not offer tracking numbers or trackable trail showing the outcome of a given search. 
 

In contrast, Referrals, Preauthorization Requests, ER Admission Notifications, and Newborn Notifications do provide a transaction tracking number.

Yes. You can add multiple service lines to a single preauthorization request each with its own CPT code.

Yes. You can submit any kind of clinical documentation needed to support the preauthorization request  while creating the request. At the end of the process, you will see an “Add Supporting Documentation” screen. You may also go back into the case after it is submitted to upload additional information. 
 

We encourage providers to submit information via the new portal in place of sending information via fax. 
 

To submit additional information after a request is submitted, select “Preauthorization” from the menu and “Search Preauthorization” from the sub-menu. You can search for and find your previously submitted preauthorization then click on the hyperlinked reference ID. This should take you to the Preauthorization Details page and you can click the “Add Supporting Documentation” button to add attachments. Note that if the Reference ID is not hyperlinked yet, please check back in a few hours as preauthorization details are not yet available.

If the user who created the original preauthorization request is not available, then any other user having affiliation to the same Tax ID(s) as the original creator, and has a role of Administrator/Office Manager or Clinical staff that provides them access to clinical information, will be able to search for the preauthorization request.

Once the preauthorization request is submitted, it cannot be changed using the portal screens. The user may, however, upload additional documents to the request and call the Utilization Management department to discuss the changes.

The user can choose the service dates for the preauthorization request. The service dates must coincide with the member’s coverage dates. 
 

The service end date cannot be more than 180 days from the request date.

The address selected must match with the sub-specialist’s Tax ID and NPI. It is a combination of these three elements (address, Tax ID, and NPI) that are critical for processing claims, preauthorization requests, and referral transactions.

Referrals

Yes. Existing referral transactions will be migrated to the new portals. Further, users will be able to search for referrals issued within the last two years. Search results, however, will only be displayed showing 90 days of information at a time.

The referral will not be “sent,” but all referrals submitted within the last 24 months will be available to the servicing provider on the Provider Portal. 
 

Referrals submitted by means other than portal, such as by fax or phone, will take some time to be seen in the portal.

Yes. Referrals may be backdated up to 30 days to facilitate member access to care.

No. The new portal will not use PRIS#s or other company-defined provider IDs.
 

The new portal will use the providers’ names and NPIs to identify them.

These are the referral visit limits:
 

For EmblemHealth members: 1-25
For ConnectiCare members: 1-9999

Notifications

Yes, you will be able to enter ER Admission Notifications or maternity/newborn cases using the “Create ER Notification” tab on the menu. This new functionality will also be available for ConnectiCare membership.

For EmblemHealth’s delegated membership, however, you will need to notify the delegated entity directly. This is a change in procedure.

While you will no longer be able to submit ER Admission Notifications for delegated members through our Provider Portal, you will be able to identify if the member falls under a delegated arrangement and will be provided with instructions for contacting the correct organization.

Attaching Documents to Transactions

You will only be allowed to attach a document in one of the following formats: doc, docx, pdf, xls, ppt, jpg, jpeg, png, bmp, gif, and txt.

You can upload up to five attachments at a time.

Yes, four 4 MB per file, up to five attachments.

The attachment can only be removed BEFORE the user selects “Upload.” Once the user selects “Upload,” the attachment cannot be removed.

Obtaining Information from the Portal

No. Refund letter requests will not be sent by, nor be available in, the portal.

The portal itself does not have a printing function. To download or print a webpage, use the browser’s print function.

Grievances & Appeals

Yes. You may use the “Ask a Question” button to submit a grievance or appeal a claim denial through the Message Center. Please use the Grievances and Appeals category so the issue can be routed to the correct staff.

You will be able to upload supporting documentation. See questions on Attaching Documents to Transactions for details. 

You will be able to upload documents in support of corrected claims but the actual process of claims correction will need to continue as it is today.

Support

You can always recover your username or reset your password if you have forgotten it by clicking on the “Forgot Username?” or “Forgot Password?” link on the Provider Portal Sign In page.

You will have to provide us with the email address on the account, and we will either remind you of your username or provide you with instructions via email to reset your password.

In order for us to be able to help you with this request, it is very important that you always keep the email address associated with the account up to date with an email account you have access to.