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Policies & Procedures

Policies and procedures for the coordinated care of our members.

EmblemHealth Coverage for Nurse Practitioner Services
Audits Involving Medicare Demand Billing and Overpayments Involving Dual Eligible Recipients
Avoiding Duplicate Claims Submissions For EmblemHealth GHI and HIP Benefit Plans
Billing
Claim Tips
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
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
Policy Enhancements for DME
Prompt Payment Guidelines
Important Information about Lidoderm/Lidocaine 5% Patch Requests
Required Use of Occurrence Codes 40 and 41 for Presurgical and Preadmission Testing
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
Right Contacts for Claims Submissions and UM
SRPP Exclusions
Submissions
Submit Claims to New HealthCare Partners Address
Submit Claims with Accurate Pay To Information
Submit PQRS Codes to CMS Directly – Not to EmblemHealth
Submitting Claims for Non Credentialed Practitioner in a Group Arrangement
Submitting Claims for Substitute Physicians
Submitting Corrected Claims
Submitting Corrected Paper Claims
Submitting Electronic Claims With Member ID Numbers
Surgical Pathology Policies
Surprise Bills and Emergency Services Uniform Notice for Out of Network Providers
Testosterone Pellet Dosage
The Importance of Accurate Taxonomy Codes
Trizetto: Our Preferred Electronic Data Interchange (EDI) Source

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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.