Medicare AdvantageBilling CodesHigh impact
Reimbursement Policies
EmblemHealth·Emergency Medicine·Provider News
Effective date
Jul 4, 2025
We identified it
Jun 28, 2026
Summary
EmblemHealth and ConnectiCare have updated multiple reimbursement policies effective July 4, 2025, including new coding edit rules (11 edits), changes to preventive care/screening, emergency department facility E&M coding, and updates to drug/biological discard modifiers (JW, JZ). Telehealth/virtual care services policies have also been revised. Billing teams must review detailed policy documents on each plan's website to identify specific coding and documentation requirements.
Action Required
By July 4, 2025: Billing team must access the full policy details at EmblemHealth.com and ConnectiCare provider websites to identify the 11 new coding edit rules and their specific affected CPT/HCPCS codes. Update billing system validation rules and claim scrubbing logic to reflect new edits for: (1) Preventive Care/Screening (Commercial and Medicaid), (2) Emergency Department Facility E&M Coding (Commercial and Medicare), and (3) Discarded Drugs/Biologicals using modifiers JW and JZ (Commercial). Review telehealth service policy updates and ensure encounter forms and billing templates reflect any new coding or documentation requirements. Verify that all staff understand which policies apply to EmblemHealth vs. ConnectiCare members. Failure to implement these edits will result in claim rejections and denials.