Because some of our PCPs have a direct contract with us (HCP DIRECT PCPs) while others do not (EmblemHealth Cohort 2 PCPs), in order to ensure you are following the correct administrative processes with HCP, you must determine each patient’s status as either an HCP DIRECT Patient or an EmblemHealth Cohort2 Patient.
There are a number of ways to identify the difference between HCP DIRECT and EmblemHealth Cohort 2 patients.
Option 1: Check member ID card
Your patient is an HCP DIRECT patient if the address listed for claims submission on the back of the ID Card is:
501 Franklin Ave, Suite 300
Garden City, New York 11530
Example 1 – HCP DIRECT EmblemHealth patient:
Your patient is an EmblemHealth Cohort 2 patient if the address listed for claims submission on the back of the ID Card is:
PO Box 2845
New York, New York 10116-2845
Example 2 – EmblemHealth Cohort 2 patient:
Option 2: Check EZ-Net
In the center of the Member Eligibility screen you will find “Member Benefit Information.” Locate the “HealthPlan” field. HIP in the first 3 positions represents an HCP DIRECT EmblemHealth patient.
Example 3 – HCP DIRECT EmblemHealth patient:
EMB in the first 3 positions of the HealthPlan field indicates EmblemHealth Cohort 2 patients.
Example 4 – EmblemHealth Cohort 2 patient:
If you have questions, or need assistance please contact our Customer Engagement Center at 1(800) 877-7587.
More information about EZ-NET
For more detailed instructions showing you how to review Member Eligibility, you can visit the EZ-Net Training Center and view the “Member Eligibility” training video.
Need EZ-Net access?
It’s easy! Simply download, complete and return the Request for EZ-Net Access form.*
*Note: You will be contacted by the EZ Net support team within 72 business hours.