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Policies & Procedures

Policies and procedures for the coordinated care of our members.

Barium Enema Screenings

National Drug Code Payment Policy

Ophthalmology Reimbursement Policy

Biosimilar Preferred Product Update

GHI PPO members are being migrated to our new claims platform

In-Office Testing List to Cover All EmblemHealth Members

After Hours and Weekend Care

Anesthesia Reimbursement

Claims Submission - Timely Filing

Maternity Claims Adjusted Procedures

Referrals for AdvantageCare Physicians Patients

Restricted Breast Cancer Surgery Facilities for Medicaid/HARP Recipients

Annual Fee Schedule Updates from CMS

Look Back Periods to Reconcile Overpayments

Performance and Supervision of Electromyographic Testing

Medicaid Rate Reduction Begins August 1

Avoiding Duplicate Claims Submissions For EmblemHealth GHI and HIP Benefit Plans

Claim Tips for Paper Submissions

Claims Submission Changes for Radiologists Treating ACPNY Members

Do Not Balance Bill Dual-Eligible Members

Home Health Billing Guide

Keep Billing Information Current

Surprise Bills and Emergency Services Uniform Notice for Out of Network Providers

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Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.