Date Issued: 6/11/2015
Each year EmblemHealth updates its systems based upon fee schedules approved by the Centers for Medicare & Medicaid Services (CMS). These updated fee schedules are used to calculate applicable payments to our practitioners. It is EmblemHealth’s policy that once the newest schedule is received from CMS, it is loaded, tested and available to pay claims within 60 days. Once loaded, claims received after the load date are paid using the updated fee schedule, if applicable, and no retroactive adjustments based on this new fee schedule will be made on claims submitted prior to the initial 60-day time frame.
