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Medicare AdvantageReimbursementHigh impact

Do Not Bill Members With Full Medicaid or QMB

EmblemHealth·CT·Reimbursement
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

Providers cannot balance bill Medicare-Medicaid dual-eligible members who have full Medicaid coverage or QMB status for any Medicare Advantage cost sharing. Medicare and Medicaid payments must be accepted as payment in full for these members.

Action Required

Action needed
Immediately: Billing team must identify Medicare-Medicaid dual-eligible members with full Medicaid or QMB status before billing. For EmblemHealth members, use ePACES system to verify coverage. For ConnectiCare members, check Connecticut Department of Social Services or call 800-842-8440. Stop all balance billing for these members and accept Medicare/Medicaid payments as payment in full. Update billing workflows to flag these member types.

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