Reimbursement Policies

06/16/2025

The following reimbursement policies have been updated. If the policy name does not have a company name shown, the policy applies to both EmblemHealth and ConnectiCare. Refer to the website applicable to the member’s plan (EmblemHealth | ConnectiCare) and see the revision histories for effective dates and applicable changes. 

  • Coding Edit Rules (11 new edits start July 4, 2025)
  • EmblemHealth’s Preventive Care/Screening (Commercial and Medicaid)
  • Emergency Department (ED) Facility E&M Coding (Commercial and Medicare)
  • Discarded Drugs/Biologicals – Modifiers JW and JZ (Commercial)
  • Telehealth/Virtual Care Services

JP69380 6/2025

Provider Update