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Medicare AdvantageReimbursementHigh impact

Do Not Bill Members With Full Medicaid or QMB

EmblemHealth·Reimbursement
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

Providers must not balance bill Medicare-Medicaid dual-eligible members with full Medicaid or QMB status for any costs beyond Medicare and Medicaid payments. These members are not responsible for Medicare Advantage cost-sharing when their Part A and Part B costs are fully covered by Medicaid.

Action Required

Action needed
Immediately: Billing team must update patient eligibility verification process to check for full Medicaid or QMB status before billing Medicare Advantage members. For EmblemHealth members, use ePACES portal to verify benefits. For ConnectiCare members, check CT Department of Social Services or call 800-842-8440. Stop all balance billing for dual-eligible members with full coverage and accept Medicare/Medicaid payments as payment in full.

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