Starting March 1, 2024, we are introducing a new Facility Fees for E&M Services on Outpatient Facility Claims (Commercial) reimbursement policy. EmblemHealth and ConnectiCare will not reimburse Evaluation and Management (E&M) codes billed on outpatient facility claims billed on a UB-04 claim form for commercial members. This policy applies to clinics that are owned, operated, or controlled by a facility or health system. Certain provider, state, or federal contract and/or mandate exceptions may apply.
In addition, the following reimbursement policies are being updated as shown in their respective revision histories:
- Commercial Preventive Services (EmblemHealth | ConnectiCare).
- Medicare Preventive Services (EmblemHealth | ConnectiCare).
- Coding Edits Policies (EmblemHealth | ConnectiCare).
- Corrected Claim Submission Policy.
- Medicare Part D Vaccines Policy.
JP 63744 11/2023
