12/10/2018

Issue with Emblem Health/HIP Referrals and/or Authorizations

I've been having ongoing problem with Emblem Health/HIP and their referral/authorization system. EVERY claim I submit, is rejected saying that authorization notification is absent. I must call to have each claim re-processed - which takes about 1/2 hour ever ytime I call. I even sent the claims as a paper claim, attaching the Referral/Authorization to the claim and also highlighting the claim number (box 23) on the HCFA claim form -- and these claims were still rejected saying authorization/referral absent. Is anyone else experiencing this problem with Emblem? Any ideas what we can do?

We are working with The NYSPMA insurance committee to try to rectify this issue as it should not be the case with the insurance company. 

We will forward this complaint to them as well and keep everyone posted on these erroneous denials.