Traditional MedicareCoverageMedium impact
Aug 2018 Reminders
EmblemHealth·Provider News
We identified it
Jun 20, 2026
Summary
EmblemHealth will deny or adjust Medicare and Medicaid claims for 'never events' - surgical or invasive procedures performed in error. All related services during the same hospitalization will also be denied, except when a correct procedure is performed after the never event.
Action Required
Immediately: Billing team must review all surgical and invasive procedure claims for potential never events before submission to EmblemHealth Medicare and Medicaid plans. Implement quality review process to identify surgical errors or wrong procedures. Document any corrective procedures performed after never events as separate, unrelated services. Claims related to never events will be denied.