New and Updated Reimbursement Policies

EmblemHealth is adding one new reimbursement policy and has updated several policies listed below.

Facility Transfer – Commercial 

In our continued efforts to provide transparency regarding our reimbursement practices, EmblemHealth has established a formal policy with payment guidelines for transfers from one inpatient acute care facility to another for related care and for emergency room transfers between outpatient facilities.

Starting July 15, 2026: For EmblemHealth commercial contracts, we will implement new reimbursement criteria for facilities transferring patients to another inpatient acute care facility for related care. Under these changes, the transferring facility will not receive payment for the day of discharge/transfer, and no outlier payments will be added under the per diem reimbursement methodology. Additionally, no reimbursement will be made for inpatient same day transfers which are defined as transfers occurring within 24 hours. 

For Medicare/Medicaid please see our Facility Transfer – (Medicare/Medicaid) Policy communicated in the March 2026 newsletter. Applicable to EmblemHealth Medicare (including commercial contracts that follow Medicare payment methodology) and Medicaid (including EmblemHealth Essential Plans) contracts only.

Updated Reimbursement Policies: See revision history for updates and effective dates.

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