CommercialAdministrativeMedium impact
New Payment Integrity Policy
EmblemHealth·Reimbursement
Effective date
Jul 1, 2024
We identified it
Jun 20, 2026
Summary
EmblemHealth and ConnectiCare are changing how they handle claims with new CPT/HCPCS codes. Starting July 2024, instead of holding entire claims when new codes aren't in their system yet, they will process all other services on the claim and reprocess the new code lines once the codes are loaded within 60 days.
Action Required
Starting July 2024: Billing team should expect partial payments on claims containing new CPT/HCPCS codes. Monitor accounts receivable for claims with new codes that may have partial adjudication, and track reprocessing of outstanding claim lines once new codes are loaded into EmblemHealth/ConnectiCare systems. Update AR follow-up procedures to account for this new partial payment process.