Policy

Policies and procedures for the coordinated care of our members

Date Issued
Title
10/3/2018
Revision in Hepatitis C Prescriber Requirements
10/2/2018
Home Health Care Medicare Maximization Services: Audits Involving Medicare Demand Billing and Overpayments Involving Dual Eligible Recipients
7/5/2018
Restricted Breast Cancer Surgery Facilities for Medicaid Recipients
6/22/2018
The Importance of Accurate Taxonomy Codes
2/6/2018
Payment Reductions on Medicare Claims
1/11/2018
UPDATE: Empire BlueCross BlueShield to perform post-service claim review for City of New York members
11/9/2017
Empire BlueCross BlueShield to perform post-service claim review for City of New York members
11/3/2016
Important Information about Lidoderm/Lidocaine 5% Patch Requests
7/15/2016
EmblemHealth Preventive Care/Screening Services Coverage
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
5/29/2015
Revisions to the HIP Diagnostic Imaging Policy for Ultrasound
3/27/2015
Costs Connected with Cosmetic Surgery Are Not Covered
10/30/2014
New York State Delays PCRI Payments for October
10/7/2014
Testosterone Pellet Dosage
7/21/2014
Prompt Payment Guidelines
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