Provider Portal Frequently Asked Questions

Last Reviewed Date: 06/28/2022

Portal Improvements

EmblemHealth continues to update the Provider Portal to make it easier to use and to simplify how we work together:

  • Starting June 24, 2022, you will be able to view utilization review determination letters for Commercial and Medicaid members within the preauthorization requests. Just scroll down to the bottom of the screen to see the new “UM Letters” section.
  • Starting July 22, 2022, new Care Plans will be added to the Member Management section on the Member Details page.
  • Printing capabilities have been improved. Consistent formatting will be used for all stages of a transaction. All data fields accessible from a screen will be printed, not just those currently visible on the screen.
  • Screen navigation has been enhanced to allow users to return to their search results when the “Back” feature is used.

ConnectiCare’s Provider Portal offers these new functions and features:

  • Starting July 22, 2022, new Care Plans will be added to the Member Management section on the Member Details page.
  • A new Message Center, including secure messaging and the ability to submit attachments.
  • The ability to submit and view preauthorization requests and ER admission notifications, upload attachments, and see their status – all 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).

Site Access

Joining Existing Group
If you have joined a practice, group, or facility (jointly organization) 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. 

Where an organization had a user(s) in the Clinical Staff Role, but did not have a registered Portal Administrator or Office Manager, the Clinical Staff’s permissions were updated to Portal Administrator or Office Manager to ensure someone has access to add new users.

If you do not know your Portal Administrator or Office Manager, please contact Provider Customer Service, Monday to Friday from 8 a.m. to 6 p.m. 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 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 a.m. to 6 p.m., 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

 

EmblemHealth Dental Provider

If you, your practice, facility, etc., have signed a brand-new contract with us, or have activated a new Tax ID, please call us at one of the numbers below and we will give you 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 portal does not allow bulk uploads of new Tax IDs or new users.

  • 212-501-4444 in New York City
  • 800-624-2414 outside of New York City

Usually, the person who oversees the patient financial services (PFS) workflow is responsible for being the key administrator – the person who maintains and obtains insurance web portal access and assigns rights to the portal. 

Where an organization had a user(s) in the Clinical Staff Role, but did not have a registered Portal Administrator or Office Manager, the Clinical Staff’s permissions were updated to Portal Administrator or Office Manager to ensure someone has access to add new users.

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 a.m. to 6 p.m. 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 

The portal does not use company-defined provider IDs.

The new portal works at a Tax ID level. Once the Administrator/Office Manager has access to a Tax ID, all providers affiliated with that Tax ID will be available to them. They may then decide which users may conduct business on behalf of each specific provider.

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.

We recommend that you 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/cciprovider/providerlogin

Make sure you are using a supported browser such as Google Chrome or Microsoft Edge when using our secure portal. Other browsers may not be supported. If you use an unsupported browser, you will be unable to access the site.

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.

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 a.m. to 6 p.m.:

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

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 on 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 (2) 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, Monday to Friday from 8 a.m. to 6 p.m.: 

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. You can 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 portal in place of sending information via fax. Sending information via fax can delay the review process. 

 

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.

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.

Initially, only UM Letters for EmblemHealth’s commercial and Medicaid members will be available through the Provider Portal. The following types of UM Letters related to preauthorization requests will be available in the Provider Portal:

  • Approvals
  • Initial adverse determinations
  • Final adverse determinations
  • Appeal determinations (commercial)
  • Action Appeal determinations (Medicaid)

Referrals

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 portal will not use company-defined provider IDs.
 

The portal uses the providers’ names and NPIs to identify them.

Notifications

Yes, you will be able to enter ER Admission Notifications or maternity/newborn cases using the “Create ER Notification” tab on the menu.

For EmblemHealth’s delegated membership, you will need to notify the delegated entity directly.

While you cannot 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 (5) attachments at a time. If you need to send us more than five (5) items, please send them in batches.

Yes, four (4) MB per file, up to five (5) 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.