Medicare AdvantageReimbursementHigh impact
Do Not Bill Members With Full Medicaid or QMB
EmblemHealth·CT·Reimbursement
We identified it
Jun 20, 2026
Summary
Healthcare providers must not balance bill Medicare-Medicaid dual-eligible members with full coverage or QMB status for any Medicare Advantage cost-sharing or additional costs. 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 with full coverage or QMB status before billing. For EmblemHealth members, use ePACES system to verify coverage status. For ConnectiCare members, check Connecticut Department of Social Services or call 800-842-8440. Stop all balance billing for identified members and accept Medicare/Medicaid payments as payment in full. Update billing workflows to flag these members.