Reprocessing NYCE PPO Plan PT/OT Claims

A system configuration issue caused certain physical and occupational therapy claims for the NYCE PPO Plan submitted between Jan. 1 and March 6, 2026, to be denied in error. This issue was resolved and there is no action providers need to take. Affected claims began reprocessing March 16, 2026. We anticipate providers will see payment within one to two weeks.

Claims submitted after March 6, 2026, will process as expected according to EmblemHealth’s payment policy Reimbursement Policy: Billing for Habilitative and Rehabilitative Services, which includes the correct coding requirements for these types of services. We extend our thanks to those who brought this issue to our attention.