EmblemHealth
Also covers / subsidiaries: HIP, GHI, Group Health Incorporated
Core Payer & Clearinghouse Profile
Electronic Payer ID
10616
55247 is for HIP plans; GHI plans use separate IDs. Confirm which legacy plan the member has via EmblemHealth's Claims Contacts chart.
Timely Filing Limit (TFL)
18 months commercial; 15 months Medicaid & Child Health Plus; 365 days Medicare (from date of service)
Appeal Window
Varies — confirm via portal / clearinghouse
Clearinghouse Gateway
TriZetto Provider Solutions (preferred)
Provider Services
877-597-5489
Claims Fax
Varies — confirm via portal / clearinghouse
Claims Address
EmblemHealth, P.O. Box 2845, New York, NY 10116-2845 (HIP professional)
Provider Portal
https://www.emblemhealth.com/providers
NY umbrella brand for two legacy plans, HIP and GHI, which carry distinct payer IDs — confirm the member's plan before submitting.
National EDI Clearinghouse Capabilities
Direct ANSI X12 electronic transaction support verified for EmblemHealth.
Associated Clearinghouse Payer IDs
National clearinghouse networks maintain dedicated routing IDs for specific transaction lines or subsidiaries under EmblemHealth.
| Clearinghouse Name | Electronic Payer ID | Status | Enrollment | Supported Services |
|---|---|---|---|---|
| Emblem Health | 10616 | Non-Par | None | 276/277 |
| Emblemhealth | 10616 | Par | None | 837P837I270/271Dental |
| Health Insurance Plan Of Greater New York (Hip/Emblemhealth) | 55247 | Non-Par | Required | 837P837I835 ERA |
| Hip Health Insurance Plan Of Greater New York | 55247 | Non-Par | None | 837P837I835 ERA |
Resolution Tools for EmblemHealth Claims
Values vary by plan, line of business, and provider agreement. Confirm in the payer portal or with your clearinghouse gateway before submitting electronic claims.
Tired of Chasing EmblemHealth Denials & Delayed Payments?
Aethera's billing specialists work EmblemHealth every day — handling EDI clearinghouse rejects, prior authorizations, payment posting, and 30-day AR aging recovery.