EmblemHealth is adopting and incorporating recent Patient-Centered Medical Home (PCMH) payment guidance from New York State (NYS) for eligible practitioners.
As a result, we will issue payments in April 2025 at the updated rates for applicable members who have selected you as their primary care physician during the months of April 2024 up to and including September 2024. This will include retroactive payment adjustments for the providers who were already paid for services rendered during the months of April 2024, May 2024, and June 2024. We will later be issuing payments for applicable members who have selected you as their primary care physician during October 2024 and up to and including March 2025.
EmblemHealth will continue to adjust the current payment schedule for the calendar year (two separate payments will be made: one payment for members who have selected you as their primary care physician during January and up to and including June, and a second payment will be made for applicable members who have selected you as their primary care physician during July and up to and including December) to align with the state fiscal year payments received by EmblemHealth. Payment amounts will be determined by the NCQA’s Patient-Centered Medical Home Recognition Program level achieved after meeting specific elements in nine standard categories, in conjunction with the number of Medicaid, HARP, and Child Health Plus patients who have selected the eligible practitioner as their primary care physician (panel size).
More information about PCMH payments can be found in this quick reference guide.
JP 68747 03/2025