Policies & Procedures

Policies and procedures for the coordinated care of our members.

Date (YYYY/MM/DD)	Title
2024/07/10	For Medical Providers: Frequently Asked Questions About Claims Payment Processing By PNC/ECHO Health
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
2022/02/17	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
2020/04/11	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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Policies & Procedures