Learn how the Bridge Program applies to NYCE PPO, Large Group, and ASO plan members in 2026.
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August 17, 2026
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Promoting wellness and preventing disease is key to the health of our oldest members.
The Centers for Disease Control and Prevention’s (CDC’s) Still Going Strong campaign speaks directly to adults age 65 and older and their caregivers, to raise awareness about preventable injuries, as well as simple steps to stay healthy and independent longer.
Your patients don’t have to give up the activities they enjoy as they get older.
This COA measure includes the percentage of adults 66 years old and up who have had a medication review or a functional status assessment. The medication review must be completed by a prescribing provider or clinical pharmacist.
Tips for doing medication reviews:
Do not include medication lists or medication reviews performed in an acute inpatient setting. Medication reviews must be documented in the same medical record and include one of the following:
- A medication review signed and dated in 2026 by the prescribing provider or clinical pharmacist with the medication list in the chart (the provider’s signature is considered evidence medications were reviewed).
- A medication list including medication names, or with dosages and frequency, and any over-the-counter (OTC) medications and herbal supplemental therapies.
- Notation with the date that the patient is not taking any medication.
- ·A medication review performed without the member present.
- ·A medication review with each visit.
Tips for performing functional status assessments
There should be one or more functional status assessments done during 2026 and the different steps in an assessment can happen during separate visits throughout the year. There are no provider-type requirements to complete this assessment. A qualifying functional assessment cannot be performed in an acute inpatient setting, or limited to an acute or single condition, event, or body system like the patient’s lower back.
Documentation in the patient’s medical record must include the date when it was performed and evidence of a complete functional assessment, including:
- Notation that Activities of Daily Living (ADL) were assessed.
- Notation of Instrumental Activities of Daily Living (IADL) were assessed.
- ·A phone or virtual visit to check-in with the patient.
By the year 2030, adults age 65 and older are projected to outnumber children for the first time in U.S. history.*
As people age, physical and cognitive function can decline and pain becomes more prevalent, impacting healthy aging and quality of life. People age 65 and older may also have more complex medication regimens. That is why we’re encouraging our providers to help patients age healthily.
Consider the best practices outlined below:
- ·Incorporate a standardized template to capture functional status, pain status, and any medications taken.
- Complete a functional status assessment and pain assessment at every face-to-face and telehealth visit.
- Ensure a medication list is in the medical record.
- Document in the medical record if the member is not taking any medication.
Together, we can help our members live healthier lives.
*U.S. Census Bureau
Funding cuts from the federal budget legislation H.R. 1 (Public Law No. 119-21) impact Essential Plan and Medicaid programs.
- Essential Plan changes affect some members starting July 1, 2026.
- Medicaid changes will take effect on Jan. 1, 2027.
The New York State Department of Health shared the resources listed below that detail the impacts of the funding cuts and include contact information for members needing assistance.
We encourage you to review the resources, take time to understand how the changes may affect members, and share the information below with your patients.
Resources:
Impact of H.R.1 Legislation on New York’s Essential Plan
Impact of Essential Plan Changes by Congressional District
Electronic funds transfer (EFT) is a faster, simpler way to get paid for your claims. If you haven’t already done so, we encourage you to take advantage of this convenient service through PNC/ECHO Health, Inc.
EmblemHealth has partnered with PNC/ECHO Health Inc. for the past six years to handle claims payments and remittances (CPR) for our providers for all EmblemHealth business except NYCE PPO.
This arrangement with PNC/ECHO simplifies our claims payment process by using one system for all payments. CPR can handle electronic payments reliably for multiple payment types. A major advantage of automated payments is the ability to receive an 835/ERA with each EFT payment. In addition, EFT payments:
- Increase speed of receiving payments.
- Significantly reduce payment processing costs.
- Streamline the accounts receivable (A/R) process.
- Reduce fraud exposure.
- Improve the accuracy and timeliness of information.
Here are answers to Frequently Asked Questions about claims payments.
For EFT/ERA enrollment and additional assistance regarding payment, contact ECHO Provider Support at 888-492-0032 or visit their website.
If you have other questions about this process, please sign in to the provider portal at emblemhealth.com/providerportal and use our live agent chat or Message Center to contact us. A provider customer service representative will be happy to help.
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