All Insurance Policy Changes (Page 339)

Continuing from page 338. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

High impact
May 2020 In The Know
EmblemHealth·Effective Jul 1, 2020
EmblemHealth announced multiple COVID-19 related changes including waived referral requirements for Medicare Advantage members during the emergency, new telehealth policies, and updated COVID-19 lab testing guidance with specific HCPCS codes. Additionally, GHI PPO City of NY members will receive new K-ID numbers effective July 1, 2020, and a 1.5% Medicaid rate reduction will begin August 1, 2020.
High impact
June 2020 In The Know
EmblemHealth·Effective Jul 1, 2020
EmblemHealth is extending preauthorization expiration dates due to COVID-19 disruptions - inpatient authorizations can be extended through provider contact, and outpatient preauthorizations are automatically extended until December 31, 2020. New member ID format (K-ID) launches July 1 for NYC EmblemHealth PPO members, and new biosimilar preferred products take effect for bevacizumab, trastuzumab, and rituximab.
High impact
July 2020 In The Know
EmblemHealth·Effective Aug 3, 2020
EmblemHealth is replacing paper check payments with virtual credit cards (vCards) starting September 2, 2020, and implementing new pharmacy preauthorization through Express Scripts starting August 3. Providers must register for EFT/ERA by August 5 to avoid receiving vCard payments instead of direct deposit.
High impact
August 2020 In The Know
EmblemHealth·Identified Jun 20, 2026
EmblemHealth prohibits charging members for COVID-19 related PPE costs (masks, gowns, gloves) and sanitizing expenses for Commercial and Medicaid plans. Any collected PPE fees must be returned to members, with potential provider sanctions for violations.
Medium impact
The 2021 EmblemHealth Risk Adjustment Program for PCPs is Underway (Jan. 1 — Dec. 31)
EmblemHealth·Effective Jan 1, 2021
EmblemHealth continues its 2021 Risk Adjustment Program partnership with Pulse8™ for NYSOH Marketplace, Medicare HMO, and Medicaid members. The program offers free monthly 60-minute webinars to help providers improve medical record documentation and claims coding accuracy for proper risk adjustment.
Low impact
New Real-Time Prescription Benefit Tool
EmblemHealth·Identified Jun 20, 2026
EmblemHealth has introduced a new Real-Time Prescription Benefit Tool (RTPB) through Express Scripts that allows providers to check prescription coverage and costs at the point of prescribing. Providers are encouraged to adopt this tool as standard practice to make informed prescribing decisions in real-time.
Medium impact
New Provider Portal – What to Expect Next
EmblemHealth·Identified Jun 20, 2026
EmblemHealth is launching a new provider portal in the coming months that will require unique email addresses for each user and enable electronic submission of Benefit Extensions and preauthorization attachments. Training materials will be provided to help with the transition from the current portal system.
Low impact
EmblemHealth Medicaid, HARP, and Child Health Plus Updates (New York State-Sponsored Programs)
EmblemHealth·Effective Jul 1, 2021
EmblemHealth now covers five Core Limited Health-Related Services for children and youth ages 21 and under placed with licensed 29-I Voluntary Foster Care Agency Health Facilities. This expands coverage for foster care services through certified agencies.
Medium impact
Medical Technologies Database
EmblemHealth·Identified Jun 20, 2026
EmblemHealth has updated their medical technologies database with new 2021 CPT/HCPCS codes and coverage decisions. Several new procedures have been approved for coverage including FoundationOne Liquid CDx (Medicare only), POEM for swallowing disorders, and PCA3 prostate cancer screening (added Commercial coverage). Multiple technologies were rejected and are not covered.
Low impact
GHI and HIPIC Renamed EmblemHealth
EmblemHealth·Identified Jun 20, 2026
GHI and HIPIC insurance companies have been renamed to EmblemHealth Plan, Inc. and EmblemHealth Insurance Company respectively. Coverage and benefits remain unchanged, but billing teams should update their systems to reflect the new company names.
Low impact
Health Care Transparency in Cost and Quality Information
EmblemHealth·Effective Dec 27, 2020
EmblemHealth can now disclose provider-specific cost and quality data to referring providers, employer groups, and members through consumer tools. They can also share de-identified claims data with business associates for plan administration and quality improvement.
Medium impact
Bridge Program to Expand to Non-ASO Members
EmblemHealth·Identified Jun 20, 2026
EmblemHealth Plan, EmblemHealth Insurance Company, and ConnectiCare are expanding their Bridge Program to offer five combined networks to large non-ASO group clients. Providers already participating in any of the listed networks (Prime Network, National Network, ConnectiCare Choice, QualCare, or First Health) will automatically be able to see these new members without additional credentialing.
Medium impact
New Provider Portal Rollout Is Underway!
EmblemHealth·Effective Jul 12, 2024
EmblemHealth and ConnectiCare are rolling out a new provider portal that began July 12, with all providers expected to transition by end of July. Each user must have a unique email address (no sharing), a designated Portal Administrator must be assigned, and Internet Explorer is no longer supported.
Medium impact
HEDIS Medical Record Request
EmblemHealth·Identified Jun 20, 2026
EmblemHealth and ConnectiCare are conducting their annual HEDIS medical record review to evaluate documentation compliance as required by state and federal agencies. Providers must respond to medical record requests within 10 business days as part of their contractual obligations.
Medium impact
EmblemHealth Preauthorization List Updated
EmblemHealth·Identified Jun 20, 2026
EmblemHealth updated their preauthorization list to version 3.6.5. The billing team should use the Preauthorization Check Tool in the provider portal for member-specific guidance rather than relying on static lists.
Medium impact
Timely Filing Requirements (Retired)
EmblemHealth·Identified Jun 20, 2026
EmblemHealth has issued a reminder about existing timely filing requirements for claims submissions. Participating providers must submit claims within 120 days post-service date, while non-participating providers have longer timeframes varying by plan type (18 months for commercial, 15 months for Medicaid, 365 days for Medicare).
High impact
Reminder: Cancer Drug Preauthorization List Expands in August
EmblemHealth·Effective Aug 15, 2021
Starting August 15, 2021, EmblemHealth and ConnectiCare expanded their prior authorization requirements to include more oncology-related chemotherapy drugs and supportive agents delivered in physician offices, outpatient hospitals, and ambulatory settings. Providers must now obtain preauthorization for these additional cancer medications before administration.
Medium impact
Enhanced Clinical Editing Processes
EmblemHealth·Effective Sep 1, 2021
EmblemHealth is expanding their partnership with Cotiviti, Inc. starting September 1, 2021, to conduct post-payment reviews of paid medical claims. These reviews will include Retrospective Accuracy datamining (RA) and Clinical Claim Validation DRG review (CCV), similar to current Optum reviews.
Medium impact
Medicaid Expands Coverage for Asthma and Diabetes Self-Management Training and Smoking Cessation Counseling
EmblemHealth·Effective Apr 1, 2021
Medicaid has expanded the list of healthcare providers who can be reimbursed for asthma/diabetes self-management training and smoking cessation counseling. Additional provider types including social workers, therapists, psychologists, nurses, optometrists, and podiatrists can now bill for these services.
Medium impact
EmblemHealth Role Permissions Table
EmblemHealth·Identified Jun 20, 2026
EmblemHealth has updated their provider portal role permissions structure, requiring designated Administrators/Office Managers to assign appropriate user roles based on job functions. Each user can only have one role per Tax ID, and Customer Service can no longer independently change user roles for HIPAA compliance.
High impact
Reminder: Taxonomy Code Enforcement for Medicaid Claims
EmblemHealth·Effective Sep 30, 2021
EmblemHealth is enforcing required Taxonomy Codes for all Medicaid claims to prevent rejections. Claims missing proper Taxonomy Codes will be rejected as 'unclean' and require resubmission.
Medium impact
2021 Annual Special Needs Plan Model of Care Training
EmblemHealth·Effective Aug 31, 2021
CMS requires providers to complete mandatory training for each dual-eligible special needs plan (D-SNP) they participate in. ConnectiCare providers must complete training by Aug. 31, 2021, and EmblemHealth providers must complete training by Oct. 31, 2021.
Medium impact
Fully Insured Members Moving to Bridge Program
EmblemHealth·Effective Aug 1, 2021
EmblemHealth is expanding network access for several large group members through their Bridge Program, allowing patients to see providers in five different networks instead of one. All billing and payment protocols remain the same under the Bridge Program guidelines.
Low impact
September is Gynecologic Cancer Awareness Month
EmblemHealth·Identified Jun 20, 2026
EmblemHealth is promoting Gynecologic Cancer Awareness Month and encouraging providers to discuss regular gynecologic screenings with patients. This is an informational announcement highlighting cervical cancer screening as a monitored quality measure, with no changes to billing requirements or procedures.
Medium impact
EmblemHealth Risk Adjustment Program for PCPs Continues
EmblemHealth·Identified Jun 20, 2026
EmblemHealth continues its Risk Adjustment Program partnership with Pulse8™ for NYSOH Marketplace, Medicare HMO and Medicaid members. The program offers free monthly 60-minute webinars to help providers improve medical record documentation and claims coding accuracy for complete patient health status capture.

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Archive by year

2023 2024 2025 2026

May 2020 In The Know

June 2020 In The Know

July 2020 In The Know

August 2020 In The Know

The 2021 EmblemHealth Risk Adjustment Program for PCPs is Underway (Jan. 1 — Dec. 31)

New Real-Time Prescription Benefit Tool

New Provider Portal – What to Expect Next

EmblemHealth Medicaid, HARP, and Child Health Plus Updates (New York State-Sponsored Programs)

Medical Technologies Database

GHI and HIPIC Renamed EmblemHealth

Health Care Transparency in Cost and Quality Information

Bridge Program to Expand to Non-ASO Members

New Provider Portal Rollout Is Underway!

HEDIS Medical Record Request

EmblemHealth Preauthorization List Updated

Timely Filing Requirements (Retired)

Reminder: Cancer Drug Preauthorization List Expands in August

Enhanced Clinical Editing Processes

Medicaid Expands Coverage for Asthma and Diabetes Self-Management Training and Smoking Cessation Counseling

EmblemHealth Role Permissions Table

Reminder: Taxonomy Code Enforcement for Medicaid Claims

2021 Annual Special Needs Plan Model of Care Training

Fully Insured Members Moving to Bridge Program

September is Gynecologic Cancer Awareness Month

EmblemHealth Risk Adjustment Program for PCPs Continues