CommercialAdministrativeHigh impact
HealthCare Partners Programs Merging Oct. 1
EmblemHealth·NY·Provider News
Effective date
Oct 1, 2021
We identified it
Jun 20, 2026
Summary
EmblemHealth is merging HealthCare Partners (HCP) Cohort 2 program with Cohort 1 effective October 1, 2021. Providers who accept HCP's direct contract invitation will follow HCP's utilization management, referral, preauthorization, and claims processing rules instead of EmblemHealth's rules.
Action Required
By October 1, 2021: Billing team must check eligibility for all members in the provider portal to identify managing entity. If HCP appears as 'Assigned Managing Entity' or HCP logo is on member ID card, follow HCP Cohort 1 protocols for utilization management, referrals, preauthorizations, ER admission notifications, and claims processing. Contact HCP at 516-941-2160 for questions. Update workflow to distinguish between HCP-managed members and EmblemHealth-managed members as processing rules differ.