Effective Oct. 1, 2022, we are introducing a new reimbursement policy to both EmblemHealth and ConnectiCare to give guidance regarding appropriate billing for services provided in a hospital/facility Treatment Room. EmblemHealth/ConnectiCare will reimburse treatment room services when a specific, identifiable procedure has been performed or a treatment rendered that is unrelated to inpatient or outpatient services is provided within the contracted global period. Treatment room services that are rendered for the sole purpose of performing a laboratory, radiology, or other diagnostic test will not be reimbursed.
ConnectiCare updated the ASC Grouper Policy to include new codes effective July 1, 2022. Ambulatory surgical groupers will be paid according to surgical contracted rates when billed with revenue codes 360 or 490. If surgical services are billed with revenue codes other than 360 or 490, and the claims contain charges for anesthesia and/or recovery room, they will be paid according to the surgical contracted rates unless otherwise negotiated.
ConnectiCare has updated the Experimental, Investigational or Unproven Services Policy to include new codes effective July 1, 2022. ConnectiCare defines the terms “investigational” or “experimental” as the use of a service, procedure, or supply that is not recognized by the health plan as standard medical care for the condition, disease, illness, or injury being treated. A service, procedure, or supply includes, but is not limited to, the diagnostic service, treatment, facility, equipment, drug, or device.