Proper Coding for Accurate Reimbursement

Date Issued: 8/24/2016

EmblemHealth requires all claims submitted with these Revenue Codes also include the appropriate HCPCS and CPT Code(s). This additional information will enable us to ensure the accuracy of our payments to you. This change applies only to the following locations of service:

Location Code Description
012XHospital Inpatient Part B
013XHospital Outpatient
014XHospital Other Part B
074XClinic OPT
075XClinic CORF
076XCommunity Mental Health Centers

Claims without the proper coding will be denied. The denial reason will indicate that a procedure code is required for the revenue code(s). If you receive a denial for this reason, you may correct and resubmit the claim.

Please Note: Revenue codes are subject to change. It is the responsibility of your office staff to ensure the most current codes are being used.