EmblemHealth, HIP, GHI: What Providers in the NY Metro Area Need to Know

Why This Matters to NY, NJ, and CT Providers

EmblemHealth is one of the largest payors in the New York metro area, with a long history and multiple affiliated brands. If you’re a provider or credentialer in New York City, Long Island, Westchester, or nearby parts of New Jersey or Connecticut, this is a name you need to understand.

Even if your contract says HIP or GHI, your patients may say “Emblem.”
Even if your provider portal login says EmblemHealth, your front desk might still be verifying benefits under a different name.

That can lead to unnecessary appointment denials, front-desk confusion, and delayed billing.

A Quick Refresher on EmblemHealth’s Company Names

EmblemHealth was formed from the merger of two legacy companies and still uses some of those names in different contexts. Here's how it breaks down:

• Group Health Incorporated (GHI) → Now operating as EmblemHealth Plan, Inc.
• Health Insurance Plan of Greater New York (HIP) → Still often referred to as HIP
• Health Insurance Company of New York → Now doing business as EmblemHealth Insurance Company

Depending on the member’s ID card or benefit plan, any of these names might appear. All are part of EmblemHealth.

Bottom line: If the patient says they have EmblemHealth, don’t turn them away just because your contract says HIP or GHI. Always verify network status.

What to Tell Your Front Desk and Scheduling Staff

Your scheduling and verification teams should be trained on the following:

• Do not deny appointments just because the name on the patient’s card is different than what’s listed in your agreement.
• Use the Check Provider Network Status tool in the EmblemHealth Provider Portal under the Member Management menu to verify participation.
• Once eligibility and plan participation are confirmed, you can proceed with scheduling—even if the patient says “Emblem” and your records say HIP or GHI.
• Consider posting internal guidance or cheat sheets to reduce confusion at intake.

Where EmblemHealth Operates

EmblemHealth is primarily a regional payor, serving members in the New York metro area, including:

• Bronx
• Brooklyn (Kings County)
• Manhattan (New York County)
• Queens
• Staten Island (Richmond County)
• Nassau and Suffolk (Long Island)
• Westchester

Through its Bridge Program, EmblemHealth has extended its network into parts of New Jersey, Connecticut, and Massachusetts, particularly through partnerships with other networks. But its main footprint is New York.

What Credentialers Should Watch For

If you’re handling credentialing or provider onboarding in New York, here’s what to keep in mind:

• EmblemHealth contracts might reference HIP or GHI depending on the legacy product.
• Your practice’s participation status may vary by product line, not just by payor name.
• If a new provider joins your practice, confirm which EmblemHealth entity they need to be enrolled with.
• For Medicare Advantage plans administered through EmblemHealth, double-check eligibility with each product line before proceeding.

One Name, Many Labels—But It’s All EmblemHealth

This isn’t just a branding issue—it’s a scheduling and revenue issue. When your staff turns a patient away because they don’t recognize the name on the ID card, it means:

• One less appointment
• One less billable service
• One more frustrated patient

Clarifying EmblemHealth’s structure—internally and with patients—can prevent costly missteps.

Need Help Making Sense of Complex Payor Networks?

If this kind of name confusion is something your team runs into often, you’re not alone. pie works with credentialing and front-office teams every day to streamline provider enrollment and eliminate confusion caused by legacy payor naming, product lines, and network structures.

👉 Want to learn how we help? Let’s talk.