CommercialReimbursementHigh impact
Reimbursement Policies
EmblemHealth·Provider News
We identified it
Jun 20, 2026
Summary
EmblemHealth and ConnectiCare have updated multiple reimbursement policies including Evaluation and Management services, coding edits, discontinued procedures with modifiers 53/73/74, and preventive care services for both commercial and Medicare plans. The billing team needs to review these policy updates and their revision histories for specific effective dates and changes.
Action Required
Immediately: Review the updated reimbursement policies at the EmblemHealth and ConnectiCare websites. Check revision histories for specific effective dates and changes to E&M services, coding edits, discontinued procedures with modifiers 53/73/74, and preventive care services. Update billing procedures accordingly based on member plan type (EmblemHealth or ConnectiCare) and plan category (Commercial or Medicare).