Updated Reimbursement Policies

Immediately: Billing team must access the full policy document at https://www.emblemhealth.com/providers/news/updated-reimbursement-policies-202609 and review the revision history to identify specific effective dates for each of the five policy updates (Hospital Readmissions, Modifier Reference, Preventive Care Services Commercial/Medicaid, Preventive Care Services Medicare, and Telehealth/Virtual Care Services). For each policy with a stated effective date: (1) Document the effective date and specific changes in your compliance tracker; (2) Update billing software, encounter forms, and prior authorization workflows as needed; (3) Brief clinical and billing staff on changes before the effective date; (4) Identify which plan types are affected (Medicare Advantage, Traditional Medicare, Medicaid, Commercial). Failure to implement changes by their respective effective dates will result in claim denials and compliance violations. Flag this document for follow-up within 48 hours once full policy details are obtained.