April 2019 In The Know

CLAIMS CORNER

Policy: Surgical Pathology Coding Policy

EmblemHealth has instituted additional payment policies for Surgical Pathology CPT Codes to help process claims consistently and in accordance with best practice standards.

Medicaid: New York State Medicaid Update

We are happy to share with you the newest issue of Medicaid Update (PDF) from the Office of Health Insurance Programs of the New York State Department of Health. Please visit the DOH Medicaid Update page.

Submission: Do not bill dual-eligible members for Medicare cost-sharing

You may not balance bill our dual-eligible HMO SNP members (EmblemHealth VIP Dual Group; EmblemHealth VIP Dual; EmblemHealth Affinity Medicare Ultimate; EmblemHealth Affinity Medicare Solutions; and ArchCare Advantage) for Medicare deductibles, coinsurance, or copayments. You may bill Medicaid as the secondary payer. Medicare and Medicaid payments must generally be accepted as payment in full. More

Informed consent required for Medicaid hysterectomy/sterilization

Federal regulations require Medicaid patients’ consent to hysterectomy and sterilization procedures. A signed consent form must be submitted for the claim to be processed. More