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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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