Posted in EmblemHealth NY, HEDIS Measures, NY Providers, Payer Updates

Hedis Measure: Controlling Blood Pressure Controlling Blood Pressure

Are you a provider that participates in reporting HEDIS measures? Then this blog post is for you!

What is this measure: the measure assesses if adults (18-85) with hypertension have their blood pressure adequately controlled, below 140/90 mm Hg. and below 130/80 Hg.

Documentation Requirements:

1. Adults 18-85 with a hypertension diagnosis. 

2. At least two visits during the measurement period with hypertension diagnoses, with a controlled reading occurring on or after the second diagnosis. 

3. Don’t forget to remove the members fhat were identified to have a nonacute inpatient admission during the measurement period.

4. Using remote devices to meet this HEDIS measure- some payers cover remote blood pressure devices ex. Emblem Health- place an order for the remote device through an In network DME provider- the cost cannot exceed $40. For this measure the patient read reading does not meet the medical criteria- the information should be transmitted to the provider from the device.


Coding: peoper codes to report the blood pressure measurements

  1. Systolic Blood Pressure CPT II:
    3074F – blood pressure less than 130 mmHg
    3075F – blood pressure 130-139 mmHg
    3077F – blood pressure greater than or equal to 140 mmHg
  2. Diastolic Blood Pressure CPT II:
    3078F – blood pressure less than 80 mmHg
    3079F – blood pressure 80‐89 mmHg
    3080F – blood pressure greater than or equal to 90

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Posted in #reimbursement, EmblemHealth NY, Payer Updates, Prior Authorization Insurance Carrier Updates, Training

Emblem Health to add more DME codes to prior auth list.

Are you a a DME provider or a physician that prescribes DME for Emblem Health members? Then this blog post is for you!

Starting on for any DOS 13,2026 and thereafter the following DME codes will be added to the prior authorization list.


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Posted in #reimbursement, EmblemHealth NY, NY Providers, Payer Updates, Training, Updates

EmblemHealth/Connecticare/Molina Health update

Are you a provider in CT or NY that serves EmblemHealth/Connecticare members-this blog post is for you!!!

Back in July of 2024, EmblemHealth announced and entered into an agreement with MolinaHealth to sell ConnectiCare (a company part of EmblemHealth).

In a Feb 2025, the sale was finalized.


So what does this mean to you as a provider?

EmblemHealth put together a reference table that the providers can utilize to check the plan/network information and which area that plan/network covers, plus description of the plans; ex deductible, copay, OON benefits, etc.

Image via EmblemHealth website.

Please visit here to view the PDF version of the whole document.

Molina also created a FAQs section that you can access from the same EmblemHealth website.


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