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Empire Blue Cross Blue Shield to Treat EI Providers as In-Network – Clarification

By now, EI Providers, who may serve Empire Blue Cross Blue Shield (Empire) children, should have received a Letter of Agreement by mail. If you provide EI services within the Empire service area, and did not receive a Letter of Agreement or if your agency adds new EI providers, please reach out to Empire at the telephone number listed below.

While Empire has received several signed Letters of Agreement, BEI, PCG and Empire have received questions from other providers. For those providers who have not yet signed and returned the Letter of Agreement, below are answers to commonly asked questions that should help you better understand the process.

Could an EI Provider be paid less money for an EI service if the contracted rate with Empire for that service is less than the EI approved rate? 
No. If the contracted rate with Empire is less than the EI rate, then providers may receive the Empire payment for the contracted amount faster than they would have otherwise received payment. Then, the amount still owed will be paid either from a secondary payer when applicable or from escrow. EI providers should NOT receive less than the EI contracted amount for an EI service.

Could an EI Provider be paid more money if the contracted rate with Empire for the EI service is greater than the EI approved rate? 
Yes. BEI understands that in some cases the contracted rate with Empire may be higher than the EI approved rate. And BEI permits providers to accept and keep any payment from Empire that is greater than the EI contracted amount. 

By signing this Letter of Agreement, is an EI provider agreeing to meet the same requirements as other providers contracted as in-network providers with Empire Blue Cross Blue Shield? 
No. EI providers will ONLY be subject to the terms of the Agreement they are signing, not to all the terms of a contract required to become an in-network provider. Providers that wish to become in-network with Empire for other lines of business (non-EI services) should follow Empire’s standard rules for becoming in-network. Unless they contract with Empire through the standard process, EI Providers that complete and return the agreement will be treated as in-network providers ONLY for the EI services they provide.

In order to be treated as an in-network provider for EI services by Empire, providers will need to sign the Letter of Agreement and return it to Empire as soon as possible. Please fax the signed agreement to 1-877-718-7153 or mail it to:

Empire Blue Cross Blue Shield
3 Huntington Quadrangle 
Provider Solutions – Mail Drop 3-4
Melville, NY 11747 
Tel: (800) 552-6630

If you have any further questions or need a copy of this “Letter of Agreement,” please call (800) 552-6630 and follow the steps below:  

1) Select Option 1: Medical Providers
2) Enter your NPI Number
3) Select Option 4: Provider Updates and Other Information
4) Select Option 1: Participation and Credentialing Information
5) Enter the zip code of the business address
6) Call the number given to you and follow any instructions you receive so you may communicate with the provider relations coordinator in your service area

If you are already in-network with Empire, please disregard this notice as no further action is required on your part.

Article ID: 299, Created On: 11/30/2015, Modified: 11/30/2015

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