Reimbursement Policy Updates

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Reimbursement Policy Updates

10/17/2023

We are introducing a formalized reimbursement policy, Multiple Procedure Payment Reduction Cardiology/Ophthalmology, which applies to both EmblemHealth and ConnectiCare. There are no changes to the guidelines or criteria we have been using to process claims.

ConnectiCare’s payment policy, ASC Grouper 2023 Commercial, was updated Oct. 1, 2023, to include new codes. 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 – claims will be paid according to the surgical contracted rates unless otherwise negotiated.

The following Reimbursement Policies have been updated. See their revision histories for applicable changes.

 

 

The following Laboratory Benefit Management (LBM) policies have also been updated. See their revision histories for applicable changes.

 

 

JP 63519 10/2023

Provider Update