How to Submit a Superbill to EmblemHealth for Therapy Reimbursement

EmblemHealth Out-of-Network Process

EmblemHealth serves members in New York and New Jersey and offers OON mental health benefits on select PPO and EPO plans. Members submit superbills through the EmblemHealth member portal at emblemhealth.com or by mailing a claim form to the OON claims processing center. EmblemHealth's behavioral health benefits are administered internally, and members should call the behavioral health number on their card for pre-authorization guidance.

Common Denial Reasons

• ✗Member has an HIP or HMO plan that excludes OON mental health coverage
• ✗Provider is not licensed in New York or New Jersey
• ✗Claim submitted after EmblemHealth's 90-day timely filing deadline
• ✗Superbill missing required revenue code or procedure code for behavioral health

Tips for Getting Reimbursed by EmblemHealth

• ✓EmblemHealth GHI PPO plans offer OON mental health benefits — verify whether the client has HIP or GHI coverage
• ✓New York's mental health parity law requires EmblemHealth to cover OON mental health at comparable rates to medical OON
• ✓EmblemHealth recommends pre-authorizing OON mental health sessions before starting treatment
• ✓Clients should request a detailed OON benefits explanation from EmblemHealth before their first appointment