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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.)

In-Office Testing List to Cover All EmblemHealth Members

After Hours and Weekend Care

Anesthesia Reimbursement

Audits Involving Medicare Demand Billing and Overpayments Involving Dual Eligible Recipients

Avoiding Duplicate Claims Submissions For EmblemHealth GHI and HIP Benefit Plans

EmblemHealth Coverage for Nurse Practitioner Services

Claim Tips for Paper Submissions

Claims Review Software

Claims Submission - Timely Filing

Claims Submission Changes for Radiologists Treating ACPNY Members

CMS has issued a new rule for Part D drugs

Corrections to H 90 Pended Reports via Q Care to Be Made Within 10 Days

Costs Connected with Cosmetic Surgery Are Not Covered

Coverage Denied for Never Events Updated Information

Do Not Balance Bill Dual-Eligible Members

EDI Transactions

EmblemHealth Consolidates Post Office Boxes for GHI HMO

EmblemHealth Coverage for Physician Assistant Services

EmblemHealth Preventive Care Screening Services Coverage

EmblemHealth Qualified Provider Reimbursement Methodology Primary Care Reimbursement Incentive

Empire BlueCross BlueShield to perform claim review for NYC members

Empire BlueCross BlueShield to perform claim review for NYC members

Home Health Billing Guide

How to Submit Medicare PPO Claims

Important Information Cost Sharing for Medicare Part B Drugs in an Outpatient Setting

Important Reminder

Inpatient transfers between acute care hospitals facilities

Keep Billing Information Current

Maternity Claims Adjusted Procedures

New Claims Submission Address for Behavioral Health

New York State Delays PCRI Payments

Now Available Electronic Commercial Coordination of Benefits Electronic Claims Transactions

Out of Network Provider Appeal Process for Denied Claims

Payment Reductions on Medicare Claims

Policy Enhancements for DME

Prompt Payment Guidelines

Referrals for AdvantageCare Physicians Patients

Restricted Breast Cancer Surgery Facilities for Mcaid Recipients

Revised Reimbursement Methodology for Services to Medicare Medicaid Dually Eligible Individuals

Revision in Hepatitis C Prescriber Requirements

Revisions to HIP Diagnostic Imaging Policy for Ultrasound

SRPP Exclusions

Surgical Pathology Policies

Surprise Bills and Emergency Services Uniform Notice for Out of Network Providers

Testosterone Pellet Dosage

The Importance of Accurate Taxonomy Codes

Updates for Nutritional Counseling Services Medical Policy

Visual Electrophysiology Testing and Corneal Ring Segments for Keratoconus Policies

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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.