Office Visit

We offer incentives to qualifying members to help encourage your patients to get preventive care and screening tests. See the Medicare Advantage Member Rewards Program flyers (EmblemHealth | ConnectiCare ) for program information and changes to our Medicare Advantage Plans for 2024. Information about the Member Rewards program also appears under “Coordinating Care for Members” in the links below: 

• EmblemHealth Medicare Advantage Plans.
• ConnectiCare Medicare Advantage Plans.

If Medicare-Medicaid dual-eligible individuals have their Part A and Part B cost-share fully covered by their Medicaid plan or are QMBs, they are not responsible for their Medicare Advantage cost-share for covered services. Please do not balance bill these members for any other costs. Any Medicare and Medicaid payments for services given to these members must be accepted as payment in full.  

For EmblemHealth members, you can use ePACES to check whether the member has full or partial Medicaid benefits. For more detail, see EmblemHealth Medicare Advantage Plans.  

For ConnectiCare members, visit the CT Department of Social Services or call 800-842-8440. For more detail, see ConnectiCare Medicare Advantage Plans.  

Visit Commercial Network and Benefit Plans to see 2024 changes. 

Keep Your Patients Covered in 2024

Please remind your patients who are enrolled in Essential Plan 3 or 4 that they may need to submit additional information on their immigration status by their submission deadline to stay covered. Share this checklist with them. If they have questions, have them call us at 888-905-4974 (TTY: 711), 9 a.m. to 6 p.m., Monday through Friday.

If your patients need help in-person, they can stop by an EmblemHealth Neighborhood Care location. 

The following preauthorization lists have been updated. See revision histories for the changes and effective dates.

• GHI PPO City of New York Preauthorization List.
• EmblemHealth/ConnectiCare Home Infusion Therapy Drug Preauthorization List.

The Pharmacy Medical Preauthorization Lists for EmblemHealth and ConnectiCare.

Our Medical Policy Committee reviewed the Clinical Practice Guidelines for EmblemHealth and ConnectiCare and approved the following updates:

New Guidelines:

• Best Practices for Adolescent Sexual and Reproductive Health Care in Clinical Settings.
• Clinical Growth Charts.
• Developmental Surveillance and Screening Resources for Pediatricians.
• Obesity in Children and Adolescents: Screening.
• Oral Health Policies & Recommendations (The Reference Manual of Pediatric Dentistry).
• Prevention of Childhood Lead Toxicity.
• Vision Screening for Infants and Children – 2022.

Updated Guidelines:

• Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2024.
• Recommendations for Preventive Pediatric Health Care.

 Removed Guidelines:

• Clinical Growth and Data Table of BMI-for-age Charts.
• Promoting Optimal Development: Identifying Infants and Young Children with Developmental Disorders Through Developmental Surveillance and Screening.
• Screening and Interventions to Prevent Dental Caries in Children Younger Than Age 5 Years.
• Screening for Obesity in Children and Adolescents.
• Sexual and Reproductive Health Care Services in the Pediatric Setting.
• Vision Screening in Children Aged 6 Months to 5 Years.
• Sexual and Reproductive Health Care Services in the Pediatric Setting.
• Vision Screening in Children Aged 6 Months to 5 Years.

New medical guidelines:

The Fetal Surgery medical guideline has been introduced for both EmblemHealth and ConnectiCare.

Revised medical guidelines:

• The EmblemHealth medical guideline for Dorsal Column Stimulator for Pain Management was updated to add Proclaim XR Spinal Cord Stimulation System to the list of limitations/exclusions as experimental/investigational for pain secondary to diabetic peripheral neuropathy.
• The EmblemHealth and ConnectiCare (commercial) medical guidelines for Mechanical Stretching Devices were updated to remove the pediatric use limitation (EmblemHealth | ConnectiCare).
• The EmblemHealth (commercial) and ConnectiCare medical guidelines for Infertility Services (EmblemHealth | ConnectiCare) were updated as follows:
  • The Freeze-All Cycles section was updated to clarify that approval for a frozen embryo transfer (FET), as a continuation of the same in vitro fertilization (IVF) cycle, will be conditional on the preimplantation genetic testing being performed. In addition, a note was added stating that a current semen analysis is not required when FET is requested.
  • Sections pertaining to Donor Services and IVF for Women without Male Partners or Exposure to Sperm added “storage” to the notes pertaining to noncovered expenses.
  • The Fertility Preservation section was updated to add a note stating that fertility preservation services are a separate benefit to preserve fertility when a medical treatment will directly or indirectly result in iatrogenic infertility and do not count toward the three-cycle limit on IVF benefits.
  • The Limitations/Exclusions section was updated to add Sperm-Hyaluronan Binding Assay (HBA) for selection of sperm for use with assisted reproduction technologies is experimental/investigational.