CommercialAdministrativeHigh impact
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 will no longer automatically assign HMO members to practices unless patients actively choose the provider as their PCP or have received care within the last two years. The insurer will run monthly and quarterly utilization reports to reassign members based on actual usage, which will directly impact capitation payments through recoupments and additional payments.
Action Required
Immediately: Contact current HMO patients who haven't been seen in nearly two years to schedule preventive visits or E&M appointments to maintain panel attribution. Track monthly utilization reports from EmblemHealth and monitor capitation payment adjustments. Implement patient outreach program to encourage active PCP selection and ensure patients understand the importance of maintaining regular care relationships to avoid being reassigned to other providers.