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Reminder: New PCP Auto-Assignment Policy for 2024
EmblemHealth·Family Medicine, Internal Medicine, General Practice·Provider News
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Starting January 1, 2024, EmblemHealth HMO members will only be assigned to practices if they actively choose the PCP or have claims showing they received care from that practice. Members without utilization will be removed from provider panels quarterly, impacting capitation payments and potentially triggering recoupments.
Action Required
Immediately: Review current HMO member panels to identify members without recent utilization who may be removed. Proactively reach out to inactive members to schedule visits or help them formally select your practice as their PCP. Monitor monthly and quarterly attribution reports from EmblemHealth. Update front desk staff to help new HMO members formally select a PCP during registration. Track capitation payment changes and prepare for potential recoupments for members who are reassigned.