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 →
EmblemHealth Claims Processing and Payment Guidelines EmblemHealth Claims Processing (clean non-Medicare claims) will be done within 30 days; paper or facsimile clean non-Medicare claims will be processed within 45 days in accordance with the New York State law for prompt payment of claims. All claims submissions must include the TIN and NPI of the rendering and billing … Read More →
Electronic Remittance Advice And Electronic Funds Transfer for EmblemHealth Claims Electronic Remittance Advice and Electronic Funds Transfer are the standards for receiving EmblemHealth payments. Electronic Remittance Advice can be processed via PNC Remittance Advantage, a no-cost online payment solution that helps your office reduce payment processing expenses and improve cash flow. With PNC Remittance Advantage, you can receive … Read More →