CommercialReimbursementMedium impact
Reimbursement Policies
EmblemHealth·Provider News
We identified it
Jun 20, 2026
Summary
EmblemHealth and ConnectiCare have updated multiple reimbursement policies including bundled services, modifier reference policies, discarded drugs coding, coding edits policies, and preventive care services. Billing teams need to review revision histories for specific effective dates and changes that may affect claim processing and reimbursement.
Action Required
Immediately: Billing team must access the revision histories for each updated policy at the source URL to determine specific effective dates and changes. Review Bundled Services policies for Commercial and Medicare, Modifier Reference policies for both carriers, Discarded Drugs/Biologicals Modifier JW policies, Coding Edits policies, and Preventive Care Services policies. Update billing system rules and encounter forms based on specific changes found in each policy revision.