CommercialReimbursementHigh impact
New and Updated Reimbursement Policies
EmblemHealth·Provider News
Effective date
Jul 15, 2026
We identified it
Jul 17, 2026
Summary
EmblemHealth is implementing new reimbursement criteria for inpatient facility transfers under commercial contracts effective July 15, 2026. Transferring facilities will no longer receive payment for the discharge/transfer day, no outlier payments will be allowed under per diem methodology, and same-day transfers (within 24 hours) will not be reimbursed. A separate policy applies to Medicare/Medicaid transfers.
Action Required
By July 15, 2026: Billing team must update billing system logic to exclude reimbursement for inpatient acute care facility transfer discharge days for EmblemHealth commercial plans. Configure system to deny payment for same-day transfers (transfers within 24 hours). Remove outlier payment calculations for per diem transfers. Update claim submission protocols and train billing staff on new transfer reimbursement rules. Review all pending facility transfer claims for EmblemHealth commercial patients to identify potential revenue impact. Note: Medicare/Medicaid transfers follow separate guidelines per March 2026 newsletter policy. Claims submitted without compliance to these rules will be denied.