Delegated Entities
Processes and pays their own radiologists claims and conducts medical necessity review
What is Evicore?
EmblemHealth’s dental services vendor who handle calls related to:
Member dental benefit information
Locating participating providers
Claim inquires
What is DentaQuest?
The preferred, independent free standing laboratory and provides most outpatient clinical services to our members.
What is Quest Diagnostics?
Processes Prior approval for certain injectable cancer, rheumatoid arthritis and multiple sclerosis drugs may be needed prior to the administration and/or purchase of the drug under a Buy and Bill program.
What is ICORE or Magellan Rx?
Administer behavioral health services
for most of EmblemHealth's members.
What is Beacon Health Options?
A specialty network and utilization management organization, to arrange chiropractic services for our
members in the benefit plans
What is Palladian?
A specialty network and utilization management organization, to arrange outpatient physical and occupational therapy (PT/OT) services.
What is Palladian?
Administers all routine exams and the dispensing of hardware based on the member’s benefit. Responsible for provider network management, credentialing, claims processing, and grievance and appeals.
What is EyeMed?
The preferred, independent free standing laboratory and provides most outpatient clinical services to our members.
What is Quest Diagnostics?
A home delivery vendor for prescription drugs to serve our EmblemHealth, GHI, HIP and Vytra plan members.
What is Express Scripts?
Largest IPA in Asian American communities in New York City. Comprised of over 850 physician members and affiliates who have access to more than 450,000 public and private insured members in the greater New York area. Med center of 14PA or 14PY
What is Coalition of Asian-American IPA, (CAIPA) ?
One of the largest multispecialty physician practices in the New York metropolitan area that provides
•Urgent care or extended hours in most locations
•Highest quality ranking in NYC
•Team-based care – ensures better health outcomes
•Full range of health services – primary care, pediatric, cardiology, OB/GYN, GI, laboratory, pharmacy, X-ray and more
•Coordinated care across 35 locations and Electronic Health Records that allow your information to travel with you
What is Advantage Care Physicians of New York (ACPNY)?
0140, 0142, 0145, 0146, 14MM Med centers processes referrals, preauthorizations and claims for plans under HMO (HM), Access I Medicare (MR), Medicare Dual Eligible SNP, HIP Essential High Option (MR), Medicaid (MD)/HARP CHPlus,
What is Montefiore or CMO?
Provider network, which is delegated for claims processing, credentialing, customer service, first level grievance and appeals, prior approvals, etc. Med Center of 14HH.
What is HealthCare Partners?
Beginning January 1, 2018, (based on approval by the NY State Department of Health), prior approval requests for DME, SNF, IRF, LTAC, and HHC services for HIP members not managed by Montefiore or Health Care Partners.
What is Evicore?