Last Reviewed Date: 08/02/2024
EmblemHealth and ConnectiCare continue to update the provider portals to make it easier to use and to simplify how we work together:
In May 2024, we introduced a new feature to let users request a modification to an existing preauthorization request or emergent inpatient admission notification. See new questions and answers added to the Preauthorization section below.
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.
If you do not know your Portal Administrator or Office Manager, please use the Provider Portal Registration Form and we will let you know who they are or help you set one up if none are available.
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.
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.
Non-Participating Providers
If you have ever submitted a claim and want to request a provider portal account now, fill out the short Provider Portal Registration Form.
Billing Company Staff
If you do not already have a user account and you need to do work for a practice, group, or facility (jointly organization) that already has a relationship with our companies, please contact their Portal Administrator or Office Manager to set up a Provider Portal account for you.
If you do not know the Portal Administrator or Office Manager for a given Tax ID, please use the Provider Portal Registration Form and we will let you know who they are.
If you already have an account linked to multiple clients, use the Provider Portal Registration Form to request your new client’s TIN to be added to your existing account.
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):
Yes. Each user will require their own username and password. They will also need a unique email address to authenticate their access.
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:
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.
You need your own User ID as you are not able to share (only one person per User ID moving forward).
Each user will need to create a new username and password (also referred to as PIN). You can create this on your own using the “Sign In” link 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
The username and password you create will work for both EmblemHealth’s and ConnectiCare’s Provider Portals.
Each portal account must have a unique email address to support multi-factor authentication. You may not share email addresses across different users.
You will use this email when you set up your password for the first time. You will also need your email if you ever need to retrieve/reset your password and username in the future.
No. One of the key improvements of this portal is the ability to consolidate all portal access needs for a user under a single email address (username).
For example, an individual who works at six hospitals, manages two faculty practice plans, and has part-time responsibilities for an outpatient offsite clinic will only need one account.
Portal access is based on the Tax ID, not the individual provider/location. In the example above, if all of the hospitals, faculty practice plans, and the outpatient clinic all use the same Tax ID, only the initial account set-up will be needed. If, however, each uses a different Tax ID and the user will use nine sign-ins, they will need to follow the account consolidation instructions to pull all information into the one account.
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.
If you have ever submitted a claim and want to request a provider portal account now, fill out the short Provider Portal Registration Form.
We posted the following training materials for your use:
Training material covers a range of topics including:
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
Benefit summaries are displayed on the portals and can be printed.
Yes. You can do so by going to “Preauthorization” on the menu, and selecting “Request Benefit Extension.”
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.
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.
The easiest way to see if you are in-network for a member is to use the Check Provider Network Status look-up tool in the Provider Portal.
Under the Member Management menu, select Eligibility or Check Provider Network Status.
Starting Aug. 26, 2022, care plans developed through any of our Care/Case Management Programs will be made available on our provider portals. Plans with highly sensitive information will not be posted. You will need to request plans with sensitive information directly from the applicable Care/Case Management team.
If you have a member who does not have a care plan, and you’d like to partner with our Care/Case Management team to develop one, please reach out to the applicable team.
Care/Case Management Teams
EmblemHealth: Call 800-447-0768 Monday through Friday from 9 a.m. to 5 p.m. See our Care Management Programs page for program descriptions and ways we can support you and your patients.
ConnectiCare: Call 800-390-3522 Monday, Thursday, and Friday from 8 a.m. to 4 p.m. or Tuesday and Wednesday from 8 a.m. to 7:30 p.m.
To review, print, or download a member’s care plan:
To submit an update to a member’s care plan on the Care Plan Details page:
Note: The turnaround times to see your update(s) post are:
If you have questions about a care plan or need a plan that has sensitive information that cannot be posted to the portal, please contact our Care Team. They are ready to assist you.
On the Care Plan Details page:
Note: The turnaround times to receive a reply are:
Responses to inquiries will be made via phone or email, not the Provider Portal. If the portal is not available, you may call:
EmblemHealth: 800-447-0768 Monday through Friday from 9 a.m. to 5 p.m.
ConnectiCare: 800-390-3522 Monday, Thursday, and Friday from 8 a.m. to 4 p.m. or Tuesday and Wednesday from 8 a.m. to 7:30 p.m.
To refer a member to one of our Care/Case Management programs:
EmblemHealth: See our Care Management Programs page for program descriptions, ways we can support you and your patients, and program-specific contact information. If you need general assistance, you can call 800-447-0768 Monday through Friday from 9 a.m. to 5 p.m.
ConnectiCare: Call 800-390-3522 Monday, Thursday, and Friday from 8 a.m. to 4 p.m. or Tuesday and Wednesday from 8 a.m. to 7:30 p.m.
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.
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.
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.
Preauthorization requests that trigger the collection of additional clinical information have an Attach File option where you can submit medical records or other supporting documentation you would like us to consider. You may now send up to 25 MG per document.
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.
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.
We will introduce automation over time. You should start to see requests for additional information in April 2023.
Submit requests and notifications through the provider portals following the same steps you use today. At the end of applicable transactions, you will be prompted to provide additional information. You will be taken to a new set of screens where you will:
Yes, you can locate these requests under the Preauthorizations tab and request allowed modifications.
Yes, all documents submitted by any provider affiliated with the request are housed in the Preauthorization Details page in the Provider Submitted Documents section.
Once you submit a modification request, you will receive a submission confirmation.
If all requested changes can be processed by our systems without staff intervention, the confirmation will let you know the modifications have been made.
If staff intervention is needed, the request will be pended and sent to our Utilization Management team for review. The confirmation will tell you to return to the portal for your request’s status.
As of January 1, 2023, referrals are no longer needed for Enhanced Care (Medicaid), Enhanced Care Plus (HARP), and Child Health Plus (CHPlus), and Essential Plan members.
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.
Yes, you will be able to enter emergent inpatient admission notifications or maternity/newborn cases using the “Create Emergent Inpatient Admission Notification” tab on the menu.
For EmblemHealth’s delegated membership, you will need to notify the delegated entity directly.
While you cannot submit elective inpatient 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.
Note: Starting April 1, 2023, Montefiore CMO will no longer be delegated to manage any EmblemHealth members. All notifications should be made directly to EmblemHealth.
By automating our processes and collecting information up front, we strive to provide faster, more consistent responses to your concurrent review. In some cases, we may be able to provide an initial concurrent review approval during the initial transaction. Automation via our portal will help reduce or eliminate the number of follow-up communications currently needed to make an informed medical necessity determination.
Note: Emergent inpatient admissions do not require preauthorization. The information requested and the approvals given are for the concurrent review of the inpatient stay.
You should start to see requests for additional information to start the concurrent review process in April 2023.
Submit notifications through the provider portals following the same steps you use today. At the end of applicable transactions, you may be prompted to provide additional information. You will be taken to a new set of screens where you will:
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.
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.
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.
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.
Please first contact the Office Manager/Administrator for your organization.
If you still have an issue, 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
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