Medicare AdvantageAdministrativeHigh impact
May 2020 In The Know
EmblemHealth·NY·Provider News
Effective date
Jul 1, 2020
We identified it
Jun 20, 2026
Summary
EmblemHealth announced multiple COVID-19 related changes including waived referral requirements for Medicare Advantage members during the emergency, new telehealth policies, and updated COVID-19 lab testing guidance with specific HCPCS codes. Additionally, GHI PPO City of NY members will receive new K-ID numbers effective July 1, 2020, and a 1.5% Medicaid rate reduction will begin August 1, 2020.
Action Required
Immediately: Update billing systems to remove referral requirements for Medicare Advantage specialist visits during COVID-19 emergency. By July 1, 2020: Billing team must update patient registration and billing systems to accommodate new 11-digit K-ID numbers for GHI PPO City of NY members and process behavioral health claims through Beacon Health Options. Use HCPCS codes U0003/U0004 for COVID-19 lab test reporting. By August 1, 2020: Apply 1.5% Medicaid rate reduction to all non-exempt services.