CommercialAdministrativeMedium impact
ConnectiCare’s Look-Back Period for Claims Adjustments
EmblemHealth·Provider News
We identified it
Jun 20, 2026
Summary
ConnectiCare has clarified that their 18-month claims adjustment look-back period applies to underpayments as well as overpayments and refunds for both commercial and Medicare members. This means the practice can now request adjustments for underpaid claims going back 18 months, not just handle overpayment refunds.
Action Required
Immediately: Billing team should review all ConnectiCare claims from the past 18 months to identify potential underpayments that can now be adjusted. Update billing procedures to include underpayment adjustments in the 18-month look-back process. Train staff on submitting adjustment requests for underpaid ConnectiCare claims within the 18-month window.