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Policies & Procedures

Policies and procedures for the coordinated care of our members.

(For EmblemHealth's anesthesia reimbursement policy please click here.)

After Hours and Weekend Care
Submissions
Anesthesia Reimbursement
Submitting Corrected Paper Claims
Policy
Trizetto: Our Preferred Electronic Data Interchange (EDI) Source
Claims Submission Changes for Radiologists Treating ACPNY Members
Submitting Electronic Claims With Member ID Numbers
Submitting Corrected Claims
Submitting Claims for Non Credentialed Practitioner in a Group Arrangement
Submit PQRS Codes to CMS Directly – Not to EmblemHealth
Submit Claims with Accurate Pay To Information
Submit Claims to New HealthCare Partners Address
Right Contacts for Claims Submissions and UM
Required Use of Occurrence Codes 40 and 41 for Presurgical and Preadmission Testing
Now Available Electronic Commercial Coordination of Benefits Electronic Claims Transactions
New Claims Submission Address for Behavioral Health
Maternity Claims Adjusted Procedures
Keep Billing Information Current
Important Reminder
How to Submit Medicare PPO Claims
EmblemHealth Consolidates Post Office Boxes for GHI HMO
EDI Transactions
Do Not Balance Bill Dual-Eligible Members
Corrections to H 90 Pended Reports via Q Care to Be Made Within 10 Days
Claims Submission - Timely Filing
Claim Tips for Paper Submissions
Claim Tips
Billing
Avoiding Duplicate Claims Submissions For EmblemHealth GHI and HIP Benefit Plans
Important Information about Lidoderm/Lidocaine 5% Patch Requests
Home Health Billing Guide
Submitting Claims for Substitute Physicians
EmblemHealth Coverage for Nurse Practitioner Services
Empire BlueCross BlueShield to perform claim review for NYC members
The Importance of Accurate Taxonomy Codes
Testosterone Pellet Dosage
Surprise Bills and Emergency Services Uniform Notice for Out of Network Providers
Surgical Pathology Policies
Revisions to HIP Diagnostic Imaging Policy for Ultrasound
Revision in Hepatitis C Prescriber Requirements
Revised Reimbursement Methodology for Services to Medicare Medicaid Dually Eligible Individuals
Restricted Breast Cancer Surgery Facilities for Mcaid Recipients
Prompt Payment Guidelines
Policy Enhancements for DME
Payment Reductions on Medicare Claims
Out of Network Provider Appeal Process for Denied Claims
New York State Delays PCRI Payments
SRPP Exclusions
Inpatient transfers between acute care hospitals facilities
Important Information Cost Sharing for Medicare Part B Drugs in an Outpatient Setting
Empire BlueCross BlueShield to perform claim review for NYC members
EmblemHealth Qualified Provider Reimbursement Methodology Primary Care Reimbursement Incentive
EmblemHealth Preventive Care Screening Services Coverage
EmblemHealth Coverage for Physician Assistant Services
Coverage Denied for Never Events Updated Information
Costs Connected with Cosmetic Surgery Are Not Covered
CMS has issued a new rule for Part D drugs
CMS has issued a new rule for Part D drugs
Claims Review Software
Audits Involving Medicare Demand Billing and Overpayments Involving Dual Eligible Recipients

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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.