CommercialAdministrativeMedium impact
Reminder: Policy Expansions
EmblemHealth·Emergency Medicine·Provider News
Effective date
Oct 1, 2024
We identified it
Jun 20, 2026
Summary
Starting October 1, 2024, EmblemHealth is expanding two existing programs to include HMO and PPO (non-NYC) Commercial, Medicare, and Medicaid plans: the ConnectiCare ED Outpatient Facility E/M Coding Reimbursement Policy using EDC Analyzer tool, and the Laboratory Benefit Management program with Avalon Healthcare Solutions. Both expansions will affect emergency department E/M coding reimbursement and laboratory benefit management for the newly included plan types.
Action Required
By October 1, 2024: Billing team must review the Laboratory Benefit Management Program Provider Training Guide at the provided link and familiarize themselves with the EDC Analyzer tool at EDCAnalyzer.com. Update billing processes to account for new reimbursement policies affecting emergency department E/M coding and laboratory benefits for EmblemHealth HMO and PPO Commercial, Medicare, and Medicaid plans (excluding NYC plans). Review full announcements for detailed implementation requirements.