Taxonomy Codes: The Importance of Accurate Taxonomy Codes Taxonomy codes are administrative codes set for identifying the practitioner type and area of specialization for health care practitioners. Each taxonomy code is a unique ten character alphanumeric code that enables practitioners to identify their specialty at the claim level. Taxonomy codes are assigned at both the individual … Read More →
HIPAA Claims EmblemHealth: Look Back Periods To Reconcile Overpayments To ensure fair and accurate HIPAA claims payment, EmblemHealth conducts audits of previously adjudicated claims. The time period for these audits is referred to as the “Look Back Period.” HIPAA claims may be audited based on the settlement or paid/check date, not the date(s) of service. The date … Read More →
Medicare Dual Eligible Members (EmblemHealth Billing Guides) Medicare Dual Eligible Members are individuals with both Medicare and Medicaid coverage. Depending on their category of Medicaid coverage, a dual eligible may receive state Medicaid plan assistance to cover their Medicare Part B premium, Medicare Parts A and B cost-share and certain benefits not covered by Medicare. … Read More →
Billing the Member or Secondary Payor (EmblemHealth Billing Requirements) Network providers, in agreeing to accept EmblemHealth’s Billing the Member and Secondary Payor requirements and reimbursement schedule for services rendered, shall not bill or seek payment from the member for any additional expenses (except for applicable copayments, co-insurance or permitted deductibles) including, but not limited to: The … Read More →