EmblemHealth will follow Medicare guidelines in the Federal COVID-19 stimulus bill (known as the “CARES Act”). Click here for more.
No COVID-19 Member Cost-Sharing
EmblemHealth members across all product lines will have no cost-sharing (including copayments, coinsurance, or deductibles) for the diagnostic visit and related lab test for coronavirus (COVID-19).
See our Temporary Telehealth Policy, containing allowable procedure codes, and Frequently Asked Questions for guidance on these services for our members. Telehealth services include visits by phone, virtual check-in, or virtual visit via Skype, FaceTime, or other video exchange.
- EmblemHealth members across all our product lines will have no cost sharing (including copayments, coinsurance, or deductibles) for in-network telehealth visits. These visits have no cost-sharing for COVID-19 and non-COVID-19 related services. Members with a benefit plan that includes the Teladoc™ program will also have no cost-sharing for Teladoc visits. The telehealth cost-sharing waiver may not apply to ASO plans.
- Click here to learn how you can use Telehealth to close gaps in care and get the data needed for commercial, Medicaid, and Medicare Advantage health plan risk adjustment programs.
For information about Teledentistry, including EmblemHealth’s guidelines for delivering services, please click here.
UM and Emergency Admission Notifications
Understanding that hospitals and other facilities must dedicate their teams and resources to patient care during the COVID-19 outbreak, on March 20, 2020, the New York Department of Financial Services issued guidance to insurers that certain standard prior authorization, concurrent review, retrospective review, and discharge planning services for inpatient hospital and emergency services must stop for 90 days. This period ends on June 18, 2020. Please click here to read more.
During the COVID-19 State of Emergency, EmblemHealth will follow CMS guidance and waive the requirement that Medicare Advantage members obtain a primary care physician referral to receive specialist services.
To address the high demand for COVID-19 testing, EmblemHealth is providing additional lab options. Quest Diagnostics is EmblemHealth’s preferred, in-network lab.
|Northwell Health Laboratories||Use CPT code 87635||516-719-1100|
|LabCorp||Use test code 139900
Use CPT code 87635
|Bio-Reference||Use CPT code 87635||833-684-0508|
If you send a specimen to a lab other than Quest, or have any collection or billing questions, please contact them at phone number above. While some of these additional labs are normally out-of-network for EmblemHealth members, we know partnering with you and providing expanded access to testing is in everyone’s best interests.
EmblemHealth does not require preauthorization for COVID-19 testing.
Screening and Coding Guidance
- Providers should make sure to follow Centers for Disease Control and Prevention (CDC) guidelines.
- New York State issued a special update on the Department of Health website: Medicaid Coverage and Reimbursement Policy for Services Related to Coronavirus Disease 2019 (COVID–19). The state’s public information page includes daily updates and additional guidance. Providers in other states should seek out guidance from their state departments of health.
- The CDC published the ICD-10-CM Official Coding Guideline with links to official diagnosis coding guidance for health care encounters and deaths related to COVID-19.
Members may also have questions about their prescription coverage and having enough maintenance medication on hand. This provider update includes information we emailed to our members on March 10.
Use our secure provider portal or fax. See this link for more information.
- Electronically submit claims for faster processing.
- Sign in to your secure portal account and make sure we have the correct email for you and your practice. If you don’t have a portal account, here is a guide for setting up your account.
- EmblemHealth is providing tips and updates to its members and the public. We are regularly updating this information and posting it here. The page includes accurate, fact-based information from our medical leadership as well as city, state, and federal authorities. Feel free to share this link with your patients.
- Centers for Medicare & Medicaid Services News Alert for March 26.
- New York State has published COVID-19 Guidance for Medicaid Providers. The state has also published Special Editions of their Monthly Medicaid Updates; here are the March and April issues.
- The New York City Department of Health hosted a webinar on how community health centers and independent practices can be authorized to enroll patients with COVID-19 in the COVID-19 Hotels Program sponsored by the City of New York. To view a recording of the 35-minute webinar, click here.