CommercialReimbursementHigh impact
Reimbursement Policy Updates
EmblemHealth·Provider News
Effective date
Mar 1, 2024
We identified it
Jun 20, 2026
Summary
Starting March 1, 2024, EmblemHealth and ConnectiCare will no longer reimburse Evaluation and Management (E&M) codes when billed on UB-04 forms for outpatient facility claims for commercial members. This affects clinics owned or operated by facilities/health systems that currently bill E&M services on facility claims.
Action Required
Before March 1, 2024: Billing team must stop billing E&M codes on UB-04 claim forms for EmblemHealth and ConnectiCare commercial members at facility-owned clinics. Switch to professional claims (CMS-1500) for E&M services or verify contract exceptions apply. Update billing system rules to prevent UB-04 submission of E&M codes for these payers. Claims submitted on UB-04 forms will not be reimbursed.