Tag: #Emblemhealth

Keeping up current on any claim timely filing updates is crucial for your business!

Claims that are denied for timely filing can be rarely appealed and get paid. (Certain situations like COB/Natural disaster)

So, I always pay a close attention to any timely filling changes that are reported by the healthcare payers/plans.

Below please note the changes that took place for Self Funded (ASO) type of plans.

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• NYS Medicaid POC Syphilis testing coverage
  Effective for any DOS August 2025 and thereafter Point of Care testing for Syphilis is covered for all fee fo service Medicaid and Managed Medicaid Members. Where is this test covered (POS)? physician/nurse practitioner/licensed midwife private office setting What kind of POC is covered and reimbursed? Currently there is only one FDA approved test -Clinical… Read more: NYS Medicaid POC Syphilis testing coverage
• NYS Medicaid OBGYN CPT II codes reporting requirement
  If you are a provider in NY and accept Managed Medicaid or Fee-for-service Medicaid plan types, then this blog post post is for you! For any DOS (for deliveries on July 1, 2024) and thereafter, the OBGYN providers billing bundled/global OBGYN codes, are also required to bill the following CPT II reporting codes. Global OBGYN… Read more: NYS Medicaid OBGYN CPT II codes reporting requirement
• NYS Medicaid: Bariatric Surgery Medical Policy Update
  Do you accept NYS Medicaid or Managed Medicaid Plan members? Then this blog post is for you! Non surgical treatment should be attempted: ex. diet and increased exercise. Bariatric Surgery Adult Patient: 18 years old and over Pediatric patients: 18 years and older – patients that are deemed physically, mentally, and emotionally mature by a… Read more: NYS Medicaid: Bariatric Surgery Medical Policy Update
• NJ Medicaid: Sickle cell Disease Generally Therapy- billing and coding
  Are you a provider in NJ that accepts NJ Managed Medicaid plans in your practice? Then this blog post is for you! When: this applies for any services done on/and after Jan 1, 2026. Who is eligible for reimbursement? Providers that are a member of the Center of International Blood and Marrow Transplant Research patient… Read more: NJ Medicaid: Sickle cell Disease Generally Therapy- billing and coding
• 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… Read more: Hedis Measure: Controlling Blood Pressure Controlling Blood Pressure