Hassle-free Administration.

Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements
View requirements for Local Plan and BlueCard Out-of-Area members.

Find a Doctor
Search our online provider directory when you need a doctor, hospital or other health care provider.

Submit Behavioral Health Claims Electronically

If you file behavioral health claims using paper submissions, you’ll be pleased to learn that Empire accepts all types of claims – including behavioral health claims – filed electronically to us or through vendors via secure connections. Switching from a paper format to electronic submission is simple and easy – you don’t need a practice management system or special software. The information below provides additional details about electronic data interchange or EDI. There’s no better time than today to begin submitting your behavioral health claims and other transactions electronically. 
Behavioral health claims have specific inpatient/outpatient criteria which can be easily transmitted electronically through our EDI gateway process including:  
Pre-Authorization Requests
Specialty Care Reviews (Referrals)
Medical Management
Benefits of electronic submission
Added convenience, increased efficiency and fewer administrative hassles are just a few of the benefits you can experience when you go electronic. You’ll also: 
Have enhanced security — You can submit and receive electronic transactions from your computer system safely and securely.
Have peace of mind — We acknowledge electronic claims immediately upon receipt, providing an audit trail of transactions submitted and processed.
Correct mistakes and get paid faster — Receive prompt notice of errors so that you can correct claims quickly – helping to ensure fast payments and a more consistent revenue cycle than that of paper submissions.
Save time and money — Claims submitted electronically help increase efficiency in your office – all while helping to reduce your administrative burden with postage, printing, mailing and other paper-related expenses.
Institutional providers can also submit behavioral health claims electronically (using the HIPAA 837I transaction) – either directly to us or via other vendors. The 837 Institutional Companion Guide and a listing of vendors are available at empireblue.com. If you are a behavioral health facility or group and unsure of how you should submit, please contact your contract manager. 
If you are currently working with a vendor and are interested in submitting claims electronically, contact the EDI Solutions Helpdesk at (800) 470-9630, Monday through Friday, 8 a.m. to 4:30 p.m., EST for other connectivity options.  
©2016 Empire BlueCross BlueShield

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., and/or HealthPlus, LLC., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans, serving residents and businesses in the 28 eastern and southeastern counties of New York State. All external sites will open in a new browser window. Please view our Website Privacy Policy for more information.