Medicaid Fee Schedule Updates

Date Issued: 9/9/2015

EmblemHealth updates its systems based upon the Medicaid fee schedules released by the New York State Department of Health (NYSDOH) via eMedNy. These updated fee schedules are used to calculate applicable payments to practitioners who are reimbursed based on the Medicaid fee schedule. It is EmblemHealth’s policy that once the newest Medicaid fee schedule is received, it is loaded, tested and available to pay claims within 60 days. Claims received after the load date are paid using the updated fee schedule, if applicable, and no retroactive adjustments based on this new fee schedule will be made on claims submitted prior to the updated fee schedule load date.