Reimbursement Policies

EmblemHealth and ConnectiCare have made updates to two reimbursement policies. See the revision histories for changes and their effective dates for the following policies: 

• Specialty Pharmacy Requirements Drug List.
• Telehealth/Virtual Care Services.

Reimbursement Policy Reminders

• Reimbursement for observation services includes all nursing care, ancillary services, and any emergency department services that preceded an observation stay. Our policies have been updated to provide additional clarity. There are no changes to the existing reimbursement criteria.
  
  For full details, please review the reimbursement policies and refer to the revision history for effective dates.
  
  Observation Stay – Commercial
  Observation Stay – Medicare and Medicaid
  
  EmblemHealth | ConnectiCare

• Starting Jan. 1, 2026, EmblemHealth and ConnectiCare are introducing Nutritional Counseling Services Reimbursement Policies. Refer to the website applicable to the member’s plan to see the relevant policy
  
  EmblemHealth | ConnectiCare