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CommercialReimbursementMedium impact

Reimbursement Policies

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

Summary

EmblemHealth and ConnectiCare have updated multiple reimbursement policies including Ambulatory Surgical Groupers, Bundled Services, Coding Edits, DME Rental vs Purchase, and Radiopharmaceuticals/Contrast Media. The Avalon Provider Training Guide has also been updated with new claim decision response examples.

Action Required

Action needed
Immediately: Review the updated reimbursement policy revision histories at the EmblemHealth provider portal. Billing team must examine changes to Ambulatory Surgical Groupers, Bundled Services, Coding Edits Policy, DME Rental vs Purchase guidelines, and Radiopharmaceuticals/Contrast Media policies. Download and review the updated Avalon Provider Training Guide for new claim decision response examples and descriptions to ensure proper claim submission processes.

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