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Policies & Procedures

Policies and procedures for the coordinated care of our members.

Date (YYYY/MM/DD) Title
2021/07/12 Enhanced Claims Editing Processes
2021/06/20 Claims Submission -Timely Filing
2021/01/05 Home Delivered Meals For Medicaid and HARP –Billing Guidance
2/17/2022 In-Office Testing List to Cover All EmblemHealth Members
2020/12/17 Look Back Periods to Reconcile Overpayments
2020/11/18 Maternity Claims Adjusted Procedures
2020/06/12 Audits Involving Medicare Demand Billing and Overpayments Involving Dual Eligible Recipients
2020/06/12 Performance and Supervision of Electromyographic Testing
2020/04/11 Restricted Breast Cancer Surgery Facilities for Medicaid/HARP Recipients
2020/01/02 Billing for Non-Covered Services
2020/01/02 Do Not Balance Bill Dual-Eligible Members
2020/01/02 Home Health Billing Guide
2020/01/02 Surprise Bills and Emergency Services Uniform Notice for Out of Network Providers
2020/01/02 Keep Billing Information Current
2015/06/15 Annual Fee Schedule Updates from CMS
2013/07/25 Out of Network Provider Appeal Process for Denied Claims
2022/04/25 Hospital Readmissions Policy - Updated

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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.