Tag: #GHI

Posted in Insurance, Updates

EmblemHealth GHI PPO-NYC members-member ID change

Posted on by KR2Medical Billing

Starting 07/01/2020, the claims for Emblem GHI PPO (NYC members) will be processed on another claims platform. In order to comply with this change the member ID’s will be changed to the format of K + 10 (numbers).

The Empire cards ( for hospital benefits) will also reflect this change- however they will display only 9 digits. Please see below:

Other notable changes:

+ Beacon Health Options will start to process Behavioral Health claims. Beacon Health Options information will be now included on the back of the EmblemHealth Cards.

+ In-office lab rules will apply to all EmblemHealth members, including GHI PPO (NYC members).

Posted in In The Know Series, Insurance, My services, Payers and CPT reinbursement

Does more GHI patients = more revenue? Year 2018

Posted on by KR2Medical Billing

In recent 2 months or so, I have seen an influx of GHI patients coming to my practice.

Great for business, right?….Well it depends on your preference and financial stability of your practice.

Let me Explain.

In the last year In Network Providers have noticed an increase in “Patient Financial Responsibility” and substantial reductions in payments for certain allergy and immunology CPT codes and/or EM codes.

For Example: CPT code like 99213 carries a $30 co-pay and payment of $17 to the provider or no co-pay and a payment of $40 or co-pay of $10 and a payment of $37 to the provider, or co-pay of $30 and a payment of $24 to the provider.

CPT code 94200- carries a $20 co-pay with no payment at all and a co-pay of $22 for CPT code 95117 with no additional payment.

Respectively lower payments compare to other payers.

Providers started to notice this trend and slowly but surely some of them started to either stop accepting new GHI patients or completely stop accepting GHI insurance all together, like ENT.

So should you accept more GHI patients? Well, it is up to you.

I personally created a specific form for GHI patients- informing them of new changes and their new Patient Financial Responsibilities. I let the patients have options to either choose to perform certain services and pay respective co-pay or opt out completely.

Now it is your turn: have you seen an increased amount of GHI patients in your practice? Do you even accept GHI?