CommercialReimbursementMedium impact
New Drugs and Biologicals Reimbursement Policy
EmblemHealth·Oncology, Rheumatology, Gastroenterology +3 more·Provider News
Effective date
Mar 1, 2024
We identified it
Jun 20, 2026
Summary
Effective March 1, 2024, EmblemHealth and ConnectiCare will align with CMS guidelines to determine which drugs and biologicals are bundled into facility charges versus reimbursed separately. The plans will follow CMS pass-through payment status for drug reimbursement decisions.
Action Required
Before March 1, 2024: Billing team must review EmblemHealth and ConnectiCare's new Drugs and Biologicals Reimbursement Policy (JP 63744) to identify which drugs/biologicals will be bundled versus separately reimbursed. Update billing software rules to align with CMS pass-through payment status. Verify billing practices match new policy to avoid claim denials.