Provider

PW_AD076907
Precertification, Case Management and Out-of-Network Referrals 
Claim Status/Review, Patient Eligibility and Ordering Referral Forms 
Claims Submission 
Referral to Network Providers 
Electronic Claim Submission 
Behavioral Health/Substance Abuse 
To Change Your Directory Listing/Other Provider File Information 
Empire Maternity Care (For PCPs and OB/GYNs) 
Member Questions 
 
 

PRECERTIFICATION, CASE MANAGEMENT AND OUT-OF-NETWORK REFERALS

Direct HMO1, HMO
Child Health PlusSM1
MediBlue1

Empire Medical Management
Phone: 1-800-441-2411
Fax: 1-800-241-5308

POS1, DirectShare POS

Empire Medical Management
Phone: 1-800-845-4741
Fax: 1-800-241-5308

EPO, PPO1, Empire Total BlueSM

Empire Medical Management
Phone: 1-800-982-8089

Traditional Indemnity

Refer to Member's ID Card

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CLAIM STATUS/REVIEW, PATIENT ELIGIBILITY AND ORDERING REFERRAL FORMS

Direct HMO1, HMO
Child Health PlusSM1
MediBlue1
POS1, DirectShare POS
EPO, PPO1, Empire Total BlueSM

Managed Care Physician Services
1-800-552-6630

BlueCard PPO2 (For Out-of-Area Members Only)

Claim Status/Review:
1-800-713-4173
Eligibility:
1-800-676-BLUE (2583)

Traditional Indemnity

Empire Physician Services
1-800-343-7283

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CLAIMS SUBMISSION

Direct HMO1, HMO
Child Health PlusSM1
MediBlue1
POS1, DirectShare POS

Empire
PO Box 1407, Church Street Station
New York, NY 10008-1407
Include YLN,YLP or unique prefix

EPO, PPO1, Empire Total BlueSM

Empire
PO Box 1407, Church Street Station
New York, NY 10008-1407
Include YLB, YLD, YLE, YLK or unique prefix

BlueCard PPO2 (For Out-of-Area Members Only)

Non-Empire member claims to:
Empire
BlueCard PPO Program
PO Box 3877, Church Street Station
New York, NY 10008-3877

Traditional Indemnity

Empire
PO Box 1407, Church Street Station
New York, NY 10008-1407
Include YLA or unique prefix

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REFERRAL TO NETWORK PROVIDERS

Direct HMO1, HMO
Child Health PlusSM1
MediBlue1
POS1, DirectShare POS

PCPs, fax referral to: 1-800-522-5793
or mail referral to:
Empire
PO Box 1407, Church Street Station
New York, NY 10008-1407
No referrals required for Direct HMO and MediBlue

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ELECTRONIC CLAIM SUBMISSION

All Plans

Electronic Commerce Services
1-866-889-7322

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BEHAVIORAL HEALTH/SUBSTANCE ABUSE

Direct HMO1, HMO

Behavioral Healthcare Management Program
1-800-626-3643

Child Health PlusSM1
MediBlue1

Behavioral Healthcare Management Program
1-800-635-6626

POS1, DirectShare POS

Behavioral Healthcare Management Program
1-800-395-7792

EPO, PPO1, Empire Total BlueSM
BlueCard PPO2 For Out-of-Area Members Only

Behavioral Healthcare Management Program
1-800-626-3643

Traditional Indemnity

Refer to Member's ID Card

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TO CHANGE YOUR DIRECTORY LISTING OR OTHER PROVIDER FILE INFORMATION

All Plans

Empire Practitioner Registry
PO Box, 3519, Church Street Station
New York, NY 10008-3519
Include your Empire Provider Number

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EMPIRE MATERNITY CARE (FOR PCPs AND OB/GYNs)

Direct HMO1, HMO
Child Health PlusSM1
MediBlue1
POS1, DirectShare POS
EPO, PPO1, Empire Total BlueSM

Empire Medical Management
1-800-845-4742

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MEMBER QUESTIONS

All Plans

Refer to Member's ID Card

1 Claims must be submitted within 180 days from date of service.
2 Empireblue.com is not available for out-of-area members covered under the BlueCard Program.

 

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