New Reimbursement Policy
We have formalized our Bundled Services Reimbursement Policy (Commercial and Medicare), which applies to both EmblemHealth and ConnectiCare. There are no changes to how claims are being paid. New codes are being added March 1, 2023. See the policy’s Revision History for the new codes.
Updated Reimbursement Policies
The following reimbursement policies are being updated. See their revision histories for effective dates and applicable changes:
- Ambulatory Surgical Grouper Policy: ConnectiCare updated the ASC Grouper Policy to include new codes effective Jan. 1, 2023. Ambulatory surgical groupers will be paid according to surgical contracted rates when billed with revenue codes 360 or 490. If surgical services are billed with revenue codes other than 360 or 490 and the claims contain charges for anesthesia and/or recovery room, claims will be paid according to the surgical contracted rates unless otherwise negotiated
