CommercialCoverageHigh impact
Observation Stay Reimbursement Policy Starts Nov. 14
EmblemHealth·Provider News
Effective date
Nov 14, 2024
We identified it
Jun 20, 2026
Summary
Starting November 14, 2024, EmblemHealth will not reimburse observation stays that are fewer than 8 hours or more than 48 hours for most members (excluding City of New York plans). This aligns EmblemHealth with existing ConnectiCare policy and follows CMS guidance on observation stay billing.
Action Required
By November 14, 2024: Billing team must update systems to flag observation stays under 8 hours or over 48 hours for EmblemHealth members (except City of NY plans). Train staff to verify observation stay duration before billing. Claims for stays outside the 8-48 hour window will be denied and should not be submitted to EmblemHealth.