New EmblemHealth Policy
Starting Sept. 13, 2024, EmblemHealth is introducing a new Habilitative and Rehabilitative Services Reimbursement Policy that describes how claims for habilitative and rehabilitative services should be reported using the appropriate modifiers. Claim lines submitted for habilitative and rehabilitative services without the appropriate modifier appended will be rejected for incorrect coding.
Updated Reimbursement Policies
The following reimbursement policies are being updated. If the policy name does not have a company name shown, the policy applies to both EmblemHealth and ConnectiCare. Lab Benefit Management policies are shown with (LBM) at the end of the policy name. See their revision histories for effective dates and applicable changes:
- Cervical Cancer Screening (LBM).
- ConnectiCare - Laboratory/Venipuncture.
- Diabetes Mellitus Testing (LBM).
- Diagnosis of Vaginitis (LBM).
- Diagnostic Testing of Common Sexually Transmitted Infections (LBM).
- DME Rental vs. Purchase.
- Drugs and Biologicals.
- Hepatitis Testing (LBM).
- Multiple & Bilateral Surgical Procedures Policy.
- Multiple Procedure Reduction Cardiology/Ophthalmology.
