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Policies & Procedures
Policies and procedures for the coordinated care of our members.
12/04/2020
Barium Enema Screenings
12/01/2020
National Drug Code Payment Policy
09/30/2020
Ophthalmology Reimbursement Policy
06/25/2020
Biosimilar Preferred Product Update
GHI PPO members are being migrated to our new claims platform
03/27/2020
In-Office Testing List to Cover All EmblemHealth Members
After Hours and Weekend Care
Anesthesia Reimbursement
Claims Submission - Timely Filing
Maternity Claims Adjusted Procedures
Policy
Referrals for AdvantageCare Physicians Patients
Restricted Breast Cancer Surgery Facilities for Medicaid/HARP Recipients
06/15/2015
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
Billing
Claim Tips
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
Our Call Center is currently experiencing extremely high volume and longer wait times. For questions related to COVID-19, visit our
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