Provider Resources

Communicating between organizations can be a challenge, especially when you need timely answers to questions about claims, member eligibility, member historical information, or when you simply need to locate other health care professionals in our network.

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The Hudson Provider Portal is designed to improve communication between Hudson Health Plan and our network of health care professionals:

  • Quick, easy, and secure online communication between Health Care Professionals and Hudson Health Plan
  • Users can verify member eligibility and download their Primary Care rosters
  • Users can view important Alerts posted by our Provider Relations Department
  • Find other physicians in Hudson's network using the Physician Lookup tool
  • Browse library of Hudson's Provider Bulletins
  • Download Claim Appeal forms and Electronic Data Interchange (EDI) Submitter Agreement and Enrollment forms
  • Keep up to date on Hudson's Supporting Excellence Program
  • Learn about Hudson's Credentialing policies

If you already have an account, click here to access the new Hudson Provider Portal.

For more information about the Hudson Provider Portal and to set up your own account, contact your Hudson Health Plan Provider Relations Representative or call 1.800.247.6550.

Also, see our  biannual newsletter for health care professionals – proHealthlines

Claims Editing Software

Hudson Health Plan uses claims editing software to ensure that all claims are paid appropriately and to provide protection against fraud and abuse. The software is called Virtual Examiner.

Virtual Examiner uses edits supported by the National Correct Coding Initiatives (NCCI) and Post Operative Period Guidelines as outlined by the Center of Medicare and Medicaid Services (CMS) as well as the Current Procedural Terminology (CPT) logic as documented by the American Medical Association (AMA). The software has not been modified with health plan specific edits.

Any questions regarding any edit or the interpretation of a rule should be directed in writing to the Provider Relations Department at Hudson Health Plan. For additional information, please contact your Provider Relations Representative.

Phone: 1.800.247.6550
Fax: 1.914.372.2035
Provider Relations Contact Form