EmblemHealth
Credentialing and enrollment guides for EmblemHealth across 2 states.
Quick Overview
Timeline
60 - 90 days
CAQH
Required
Re-credentialing
Every 3 year(s)
States Available
2
How EmblemHealth Credentialing Actually Works
Verified July 2026Apply Through
Timeline
Not published by the payer
Recredentialing
Not published by the payer
EmblemHealth is the New York plan family built from the GHI and HIP heritage networks. Credentialing works from your CAQH ProView data through its provider enrollment channels.
The stall to avoid: GHI and HIP heritage networks are distinct participations under the EmblemHealth umbrella: confirm which networks your contract covers.
From PayerReady's payer enrollment research, built from the payer's own provider manuals and enrollment pages. Payer processes change; when a fact is not published by the payer, we say so rather than guess.
About EmblemHealth
EmblemHealth is a nonprofit health insurer serving over 3 million members primarily in New York. They offer commercial, Medicare, Medicaid, CHIP, and individual marketplace plans through their EmblemHealth and ConnectiCare brands.
How to Get Credentialed
Gather Required Documents
Collect all necessary credentials including your medical license, DEA certificate, malpractice insurance, NPI number, and board certifications.
Complete Your CAQH ProView Profile
EmblemHealth requires a current CAQH ProView profile. Create or update your profile at proview.caqh.org.
Submit Your Application
Submit your completed enrollment package to EmblemHealth. Select your state below for state-specific submission details.
Track & Follow Up
Credentialing typically takes 60-90 days. Monitor your application and respond promptly to requests for additional information.
Free Consultation
Need help enrolling with EmblemHealth?
Our specialists handle the entire EmblemHealth enrollment process: applications, follow-ups, and approvals across all 50 states.
Required Documents
Board Certification
Required if board certified; highly recommended
CV/Resume
DEA License
Required if prescribing controlled substances
Malpractice Insurance
Medical Degree
Medical License
NPI Certificate
Professional Reference
Enrollment Forms
CAQH ProView
Universal credentialing application used by most commercial and BCBS payers.
Contact Information
Provider Credentialing
1-877-842-9396
Fax: 1-646-447-7738
Mon-Fri 9am-5pm ET
Provider Relations
1-877-842-9396
Mon-Fri 9am-5pm ET
Claims
1-877-842-9396
Quick Links
Available States
Reviewed by the PayerReady Credentialing Team
Our credentialing specialists verify every article against current CMS regulations, NCQA standards, and payer-specific enrollment requirements. See our editorial process.
Select Your State
Choose your state for EmblemHealth-specific credentialing details including timelines, contacts, and local requirements.
EmblemHealth credentialing requirements by state
EmblemHealth enrollment is not identical everywhere. The table below lists what actually differs across the 2 states EmblemHealth operates in — network status, local plan names, portals and the state-specific conditions our credentialing team has recorded.
| State | Network | State-specific notes |
|---|---|---|
| Connecticut | Open | — |
| New York | Open | — |
Compiled and maintained by the PayerReady credentialing team from payer portals and direct payer contact. Last verified April 2, 2026. Network status changes without notice — confirm before you file.
Common questions about EmblemHealth credentialing
How long does EmblemHealth credentialing take?
EmblemHealth credentialing typically takes 60–90 days from a complete submission to an approved effective date. Incomplete applications are the main cause of delay: a missing document or an unattested CAQH profile restarts the clock rather than pausing it.
Does EmblemHealth require CAQH?
Yes. EmblemHealth pulls provider data from CAQH ProView, so your profile must be complete, attested and shared with EmblemHealth before the application can move. CAQH re-attestation runs on a 120-day cycle, and a lapsed attestation stalls both new enrollments and recredentialing.
Which states does EmblemHealth operate in?
EmblemHealth has credentialing operations in 2 states. 2 of those 2 currently show an open panel. Requirements are not uniform: local plan names, provider portals and state-specific conditions differ, which is what the state-by-state table above records.