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Medicare AdvantageReimbursementHigh impact

Do Not Bill Members With Full Medicaid or QMB

EmblemHealth·CT·Reimbursement
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

Medicare-Medicaid dual eligible members with full Medicaid benefits or QMB status cannot be balance billed for Medicare Advantage cost-sharing. Providers must accept Medicare and Medicaid payments as payment in full and cannot bill these members for additional costs.

Action Required

Action needed
Immediately: Billing team must identify Medicare-Medicaid dual eligible members with full Medicaid or QMB status before billing. For EmblemHealth members, use ePaces system to verify Medicaid benefit level. For ConnectiCare members in Connecticut, verify through CT Department of Social Services or call 800-842-8440. Stop all balance billing for these members and accept Medicare/Medicaid payments as payment in full. Update billing system rules to flag these member types.

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