CommercialReimbursementMedium impact
Reimbursement Policies
EmblemHealth·Provider News
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
EmblemHealth and ConnectiCare updated reimbursement policies for specialty pharmacy drug lists, telehealth services, and observation stays with clarifications but no changes to existing criteria. A new Nutritional Counseling Services Reimbursement Policy will be introduced starting January 1, 2026.
Action Required
By January 1, 2026: Review and prepare for new Nutritional Counseling Services Reimbursement Policy implementation. Billing team should access EmblemHealth and ConnectiCare websites to review updated specialty pharmacy drug lists and telehealth service policies. Review observation stay billing procedures to ensure compliance with clarified reimbursement guidelines for nursing care, ancillary services, and preceding emergency department services.