MedicaidAdministrativeHigh impact
EmblemHealth Will Deny Claims Submitted by Providers Who Are Not Enrolled in NYS’ Medicaid Program
EmblemHealth·NY·Provider News
Effective date
Sep 1, 2022
We identified it
Jun 20, 2026
Summary
Starting September 1, 2022, EmblemHealth will deny all Medicaid, HARP, and Child Health Plus claims from providers who are not enrolled in New York State's Medicaid Fee-For-Service program. This applies to both in-network and out-of-network providers, including those who furnish, order, prescribe, or refer services.
Action Required
Before September 1, 2022: All providers must enroll in the New York State Medicaid Fee-For-Service program as either a billing provider or OPRA (Order/Prescribe/Refer/Attend) provider. Billing team must verify enrollment status for all providers submitting EmblemHealth Medicaid, HARP, and Child Health Plus claims. Update credentialing tracking system to monitor NYS Medicaid enrollment status. Claims will be denied if providers are not enrolled or in pending enrollment status.