Medicare AdvantageReimbursementHigh impact
Do Not Bill Members With Full Medicaid or QMB
EmblemHealth·CT·Reimbursement
We identified it
Jun 20, 2026
Summary
Healthcare practices must stop balance billing Medicare-Medicaid dual-eligible members and Qualified Medicare Beneficiaries (QMBs) who have full cost-share coverage. Medicare and Medicaid payments must be accepted as payment in full for these members.
Action Required
Immediately: Billing team must identify Medicare-Medicaid dual-eligible members and QMBs in patient accounts and stop all balance billing for these patients. For EmblemHealth members, use ePACES system to verify full or partial Medicaid benefits before billing. For ConnectiCare members, verify benefits through Connecticut Department of Social Services or call 800-842-8440. Update billing workflows to accept Medicare and Medicaid payments as payment in full for covered services.