Encompass emblemhealth

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PCPs may also refer higher-risk adolescents to a behavioral health practitioner. For help finding a Montefiore mental health or substance abuse practitioner, call EmblemHealth manages behavioral and physical health services for Medicaid-enrolled children and youth under 21 years of age. EmblemHealth uses aggregated data from its care management and claims systems to identify trends and opportunities for improving member care.

We use additional strategies to promote behavioral health-medical integration for children, including at-risk populations. These strategies include:. The following behavioral health benefits are covered:. In some cases, non-routine behavioral health services require preauthorization. Routine Outpatient Services — No Preauthorization.

Preauthorization is not required for routine outpatient services. These services include initial consultation and individual, group, family, couple, and collateral treatment. See Who to Contact for Preauthorization. Once Beacon approves the service, you must notify your patient of the approval. You must notify Beacon if you are unable to reach your patient or their designee. Beacon administers the Case Management Program for all members except for those with the Montefiore logo on their ID card.

Members with the greatest risk of needing intensive behavioral health services, including inpatient care, are eligible for case management services. Case managers contact enrolled members, devise a treatment care plan, and coordinate with treatment provider s to assist with medication adherence and treatment plan compliance. The program involves frequent telephonic counseling sessions with the case manager and face-to-face visits in the community, when possible, to keep the member out of the hospital.

For electronic claims: Beacon encourages electronic claims submission through its secure ProviderConnect website, or through a clearinghouse. For paper claims:. Medicare members: Submit to EmblemHealth.

Montefiore members treated by Montefiore network: Submit to Montefiore. All other members: Submit to Beacon. Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider.

If you have any concerns about your health, please contact your health care provider's office. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan.

Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.

Switch to: members brokers employers. Sign in Contact Us Search. Navigation Open. Switch to:. Clinical Corner. Quality Improvement Find our Quality Improvement programs and resources here. Search Our Quality Improvement Page.

Claims Corner. Reimbursement Policies Payment processes unique to our health plans Payment Integrity Policies How we pursue payment accuracy. Provider Manual. Provider Manual Find the specific content you are looking for from our extensive Provider Manual. Search the Provider Manual.

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Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan.

Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. Switch to: members brokers employers. Sign in Contact Us Search. Navigation Open. Switch to:. Clinical Corner. Quality Improvement Find our Quality Improvement programs and resources here. Search Our Quality Improvement Page. Claims Corner. Reimbursement Policies Payment processes unique to our health plans Payment Integrity Policies How we pursue payment accuracy.

Provider Manual. Provider Manual Find the specific content you are looking for from our extensive Provider Manual. Search the Provider Manual. Dental Corner. Welcome Dental Providers Find a Dentist. Want to be a change agent who impacts the community and helps deliver health care? Explore open positions today. Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider.

If you have any concerns about your health, please contact your health care provider's office. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.

Switch to: providers brokers employers. Navigation Open. Switch to:. Careers Why Work with Us? EmblemHealth Family of Companies. A primary and specialty care practice. Well-being solutions for companies and their employees.

Find a Doctor. Find Care Find a doctor, dentist, specialty service, hospital, lab and more. Telehealth About Telehealth How to Enroll. Member Sign In If you're already a member, finding the right care is as easy as signing in to your myEmblemHealth account. Sign In. Our Plans. We've got you covered Our plans are designed to provide you with personalized health care at prices you can afford. Get a Quote. Member Resources. Live Well.

Guidance on the Baby Formula Shortage As the baby formula shortage continues, there are certain precautions you should take. Learn More. Caring for New York for Generations. Browse Plans. Enroll Now for Health Coverage. Explore Plans.

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