Medicare AdvantageReimbursementMedium impact
Reminders: Reimbursement Policies Effective Aug. 1, 2022
EmblemHealth·Provider News
Effective date
Aug 1, 2022
We identified it
Jun 20, 2026
Summary
EmblemHealth and ConnectiCare implemented new reimbursement policies for Durable Medical Equipment (DME) effective August 1, 2022, covering both office/non-facility place of service and rental vs. purchase decisions. Updated coding edits now apply to PPO members with Medicare PPO and commercial PPO plans for City of New York and non-City PPO members.
Action Required
Immediately: Billing team must review and implement the new EmblemHealth DME reimbursement policies for office/non-facility place of service billing and rental vs. purchase determinations. Update billing system rules to apply new coding edits for EmblemHealth PPO members with Medicare PPO and commercial PPO plans. Verify place of service coding accuracy for all DME claims to ensure proper reimbursement.