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Policies & Procedures

Policies and procedures for the coordinated care of our members.

Date Issued (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
2020/12/01 National Drug Code Payment Policy
2020/12/23 In-Office Testing List to Cover All EmblemHealth Members
2020/12/17 Look Back Periods to Reconcile Overpayments
2020/12/04 Barium Enema Screenings
2020/11/18 Maternity Claims Adjusted Procedures
2020/06/25 Biosimilar Preferred Product Update
2020/06/12 Audits Involving Medicare Demand Billing and Overpayments Involving Dual Eligible Recipients
2020/06/12 Referrals for AdvantageCare Physicians Patients
2020/06/12 Performance and Supervision of Electromyographic Testing
2020/06/10 GHI PPO members are being migrated to our new claims platform
2020/04/11 Restricted Breast Cancer Surgery Facilities for Medicaid/HARP Recipients
2020/01/02 Avoiding Duplicate Claims Submissions For EmblemHealth GHI and HIP Benefit Plans
2020/01/02 Billing
2020/01/02 Claim Tips
2020/01/02 Claim Tips for Paper Submissions
2020/01/02 Claims Submission Changes for Radiologists Treating ACPNY Members
2020/01/02 Do Not Balance Bill Dual-Eligible Members
2020/01/02 Home Health Billing Guide
2020/01/02 How to Submit Medicare PPO Claims
2020/01/02 Surprise Bills and Emergency Services Uniform Notice for Out of Network Providers
2020/01/02 Keep Billing Information Current
2019/04/29 Policy
2015/06/15 Annual Fee Schedule Updates from CMS
2013/07/25 Out of Network Provider Appeal Process for Denied Claims

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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.