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New and Updated Reimbursement Policies
Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
Oct 16, 2026
Summary
EmblemHealth has established a new formal reimbursement policy for obstetrical/maternity care services and updated multiple existing reimbursement policies (Coding Edits, E&M Services, Modifier Reference, Preventive Medicine and Screening, Prolonged Services, and Telehealth/Virtual Care Services) to align with AMA code changes effective January 1, 2027. The billing team must review the revision history for specific effective dates and implementation requirements for each updated policy.
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What to do
by Jan 1, 2027 · 4 steps
01Billing team must access the full EmblemHealth Reimbursement Policies documentation (referenced at https://www.emblemhealth.com/providers/news/reimbursement-policies-202610) to review the revision history for the new Obstetrical/Maternity Care Services policy and updates to Coding Edits Policy, E&M Services, Modifier Reference Policy, Preventive Medicine and Screening, Prolonged Services, and Telehealth/Virtual Care Services policies.
02Identify specific effective dates and code changes applicable to each policy.
03Update billing workflows, code sets, modifiers, and documentation requirements in the billing system to comply with all stated policy changes before the January 1, 2027 AMA code change date.
04Verify applicability across all affected plan types (Commercial, Medicare, and Medicaid) and confirm practice-specific implementation timelines.
Original notice
New and Updated Reimbursement Policies
emblemhealth.com · Always check the source before changing claims.