MedicaidReimbursementMedium impact
Payment Integrity Policies
EmblemHealth·NY·Reimbursement
Effective date
Nov 1, 2025
We identified it
Jun 20, 2026
Summary
EmblemHealth has introduced a new Payment Integrity Policy addressing Medicaid Benchmark Rate Adjustments based on New York State Department of Health facility-specific benchmark rates. The policy also updates existing payment integrity policies including Annual Fee Schedule Updates and Device/Implant coding guidelines for facilities.
Action Required
By November 2025: Billing team must review updated EmblemHealth payment integrity policies at the source URL for specific benchmark rate adjustments. Update billing systems to reflect any new Medicaid reimbursement rates for New York facilities. Monitor revision histories for Annual Fee Schedule Updates and Device/Implant coding guidelines to ensure compliance with facility-specific benchmark adjustments.