Policy

Policies and procedures for the coordinated care of our members

Date Issued
Title
11/30/2016
Medicaid Expansion of Coverage for Surgical First Assistants
11/23/2016
Submitting Claims with Gender/Procedure Conflict
11/3/2016
Important Information about Lidoderm/Lidocaine 5% Patch Requests
8/24/2016
Proper Coding for Accurate Reimbursement
8/15/2016
Suppression of Member Explanation of Benefits (EOBs) for Medicaid Minors
7/15/2016
EmblemHealth Preventive Care/Screening Services Coverage
6/16/2016
Procedures Requiring Clinical Review for Prior Approval
5/17/2016
CMS has issued a new rule for Part D drugs
4/18/2016
Revised Reimbursement Methodology for Services to Medicare/Medicaid Dually Eligible Individuals
2/2/2016
Surprise Bills and Emergency Services Uniform Notice for Out of Network Providers
11/18/2015
2016 Medical Policy Revisions
10/13/2015
Coverage Policy for Helicobacter Pylori
6/23/2015
Coding—New Oral Antiemetic Drug Akynzeo®
3/27/2015
Costs Connected with Cosmetic Surgery Are Not Covered
1/26/2015
Submitting Claims for Substitute Physicians
10/30/2014
New York State Delays PCRI Payments for October
10/7/2014
Testosterone Pellet Dosage
7/21/2014
Prompt Payment Guidelines
2/28/2014
Medicare 2014 Summary of Changes
10/16/2013
EmblemHealth Qualified Provider Reimbursement Methodology Primary Care Reimbursement Incentive
9/4/2013
Important Information Cost Sharing for Medicare Part B Drugs in an Outpatient Setting
7/25/2013
Out-of-Network Provider Appeal Process for Denied Claims
7/17/2013
EmblemHealth Coverage for Nurse Practitioner Services
7/17/2013
EmblemHealth Coverage for Physician Assistant Services
3/11/2013
New HIP Outpatient Imaging Self-Referral Payment Policy
11/22/2012
Look Back Periods to Reconcile Overpayments
10/28/2010
Changes to the In-Office Testing List for CompreHealth, HIP and Vytra Plans
8/19/2010
Coverage Denied for Never Events
4/28/2010
Claims Review Software