Updated COVID-19 UM and Emergency Notification Guidance from New York State

Effective June 19, 2020, the New York State Department of Financial Services lifted some of its emergency requirements for health plans and COVID-19. EmblemHealth will resume retrospective review of all affected services rendered during the suspension period, except as prohibited by law.
 

For the original New York State announcement, please read the March 20 DFS Insurance Circular Letter 8.

Please note:

  • The state has lifted the tolling of time frames (delay) for facilities to file internal and external appeals (e.g., for adverse determination and final adverse determination). Standard time frames for filing appeals have resumed.
  • Audits of hospital payments and overpayment recoveries, which were suspended on March 20, 2020, may now proceed.

If you have questions about the State’s guidance or your continued interactions with EmblemHealth, please contact your relationship manager.
 

Thank you for caring for our members during this unprecedented time.