EmblemHealth Plan
Part of EmblemHealth, Inc.
Summary
EmblemHealth Plan is a regional health plan, part of EmblemHealth, Inc., offering dental, medical, and vision coverage operating in New York, New Jersey, and Connecticut. Claims route under payer ID 13551, with 9 alternate IDs in use across clearinghouses. Provider enrollment typically takes 60-90 days, with applications through EmblemHealth Provider Portal, and CAQH is used for credentialing data. Through clearinghouses it supports eligibility checks, claim status inquiries, professional claims, institutional claims, dental claims, and electronic remittance (ERA); ERA enrollment is required and takes several weeks.
At a glance
- Payer ID
13551Also seen as 10407, 10616, 10808, 2744, 6509, EMBLEM and 3 more- Also known as
- EmblemHealth - Group Health Incorporated, GHI - New York, Vytra
- Uses CAQH
- YesApplication route: CAQH application only
- Service area
- NY, NJ, CT
Clearinghouse transaction setup
Which EDI transactions this payer supports, and how long clearinghouse enrollment typically takes when it is required.
| Transaction | Enrollment | Typical setup |
|---|---|---|
| Eligibility checks (270/271) | Not required | Immediate |
| Claim status (276/277) | Not required | Immediate |
| Professional claims (837P) | Not required | Immediate |
| Institutional claims (837I) | Not required | Immediate |
| Dental claims (837D) | Not required | Immediate |
| ERA / remittance (835) | Required | Several weeks |
Common questions
- What is the payer ID for EmblemHealth Plan?
- The payer ID for EmblemHealth Plan is 13551. Alternate IDs seen across clearinghouses include 10407, 10616, 10808, 2744.
- How long does EmblemHealth Plan provider enrollment take?
- EmblemHealth Plan provider enrollment typically takes 60-90 days from application to effective date. Timelines vary by state, plan, and how complete the application is.
- Does EmblemHealth Plan require CAQH?
- Yes. EmblemHealth Plan uses CAQH for credentialing data, so keep the provider's CAQH profile current and attested before applying.
- Does EmblemHealth Plan require ERA enrollment?
- Yes. EmblemHealth Plan requires a separate ERA (835) enrollment before electronic remittances flow, and setup typically takes several weeks.
- What states does EmblemHealth Plan cover?
- EmblemHealth Plan operates in NY, NJ, CT. Coverage can differ by plan and product line, so confirm the specific plan before you file.
Related payers
Compiled from public payer resources and clearinghouse catalogs. Details change often, so confirm with the payer before relying on them. Spot something out of date? Tell us and we will fix it.