New York
Provider Communications

Articles

Title Publication Category Date

Updated COVID-19 Medicare and Medicaid Information

For the latest COVID-19 Medicare and Medicaid information, please check Medicaid Provider News - COVID-19 and Important Medicare Advantage Updates.
COVID-19 Information State & Federal Mar 25, 2020

Reimbursement Policy Updates

August 2018 Empire Provider Newsletter Reimbursement Policies Aug 1, 2018

Reimbursement Policy update - Outpatient Facility Edit Implementation

January 2020 Empire Provider News Reimbursement Policies Jan 1, 2020

Distinct Procedural Services- Modifiers 59, XE, XP, XS, XU (Professional)

September 2020 Empire Provider News Reimbursement Policies Sep 1, 2020

Frequency Editing (Professional)

September 2020 Empire Provider News Reimbursement Policies Sep 1, 2020

Injectable Substances with Related Injection Services - (Professional)

February 2019 Empire Provider Newsletter Reimbursement Policies Feb 1, 2019

Body Mass Index (BMI) - Facility

February 2019 Empire Provider Newsletter Reimbursement Policies Feb 1, 2019

Reminder Review ICD-10-CM Coding Guidelines - Professional

February 2019 Empire Provider Newsletter Reimbursement Policies Feb 1, 2019

Professional Reimbursement Policy Update

June 2018 Empire Provider Newsletter Reimbursement Policies May 30, 2018

Reimbursement Policy Reminder - Durable Medical Equipment (Professional)

June 2018 Empire Provider Newsletter Reimbursement Policies May 30, 2018

Clinical Laboratory Improvements Amendments for Empire

February 2020 Empire Provider News Reimbursement Policies Feb 1, 2020

Empire to enhance claim edits for Outpatient Facility Claims

June 2021 Newsletter Reimbursement Policies Jun 1, 2021

New reimbursement policy: Non-patient Laboratory Services (Facility)

Material adverse change (MAC) notification
July 2021 Newsletter Reimbursement Policies Jul 1, 2021

Reimbursement policy update: Consultations (Professional)

Material adverse change (MAC) notification
July 2021 Newsletter Reimbursement Policies Jul 1, 2021

New Reimbursement Policy Durable Medical Equipment - Rent to Purchase and Durable Medical Equipment - Modifiers (Professional)

December 2019 Empire Provider News Reimbursement Policies Dec 1, 2019

System updates for 2020 - Professional

December 2019 Empire Provider News Reimbursement Policies Dec 1, 2019

Reimbursement policy update: Sexually Transmitted Infections Testing (Professional)

Material adverse change (MAC) notification

September 2021 Newsletter Reimbursement Policies Sep 1, 2021

Reimbursement policy update: Drug Screen Testing (Professional)

Material adverse change (MAC) notification
September 2021 Newsletter Reimbursement Policies Sep 1, 2021

Reimbursement policy reminder Professional Anesthesia Services (Professional)

September 2021 Newsletter Reimbursement Policies Sep 1, 2021

New Reimbursement Policy: Nurse Practitioner and Physician Assistant Services - Professional

June 2020 Empire Provider News Reimbursement Policies Jun 1, 2020

Frequency Editing - Professional

June 2019 Empire Provider Newsletter Reimbursement Policies Jun 1, 2019

Ambulance Transportation - Professional

June 2019 Empire Provider Newsletter Reimbursement Policies Jun 1, 2019

Reimbursement Policy updates

July 2019 Empire Provider News Reimbursement Policies Jul 1, 2019

Inpatient Readmission (Facility)

August 2021 Newsletter Reimbursement Policies Aug 1, 2021

Distinct Procedural Service, Modifiers 59 and XE, XP, XS, & XU

Material adverse change (MAC) notification
August 2021 Newsletter Reimbursement Policies Aug 1, 2021

Virtual Visits - Professional and Facility

Material adverse change (MAC) notification

August 2021 Newsletter Reimbursement Policies Aug 1, 2021

Reimbursement Policy update

October 2019 Empire Provider News Reimbursement Policies Oct 1, 2019

Reminder about System Updates

May 2020 Empire Provider News Reimbursement Policies May 1, 2020

Outpatient Surgical Grouper

May 2020 Empire Provider News Reimbursement Policies May 1, 2020

Bundled Services and Supplies (Professional)

December 2020 Empire Provider News Reimbursement Policies Dec 1, 2020

Empire expands hospice policy

December 2020 Empire Provider News Reimbursement Policies Dec 1, 2020

Emergency Room Transfers (Facility)

Material Adverse Change (MAC) Notification
February 2021 Empire Provider News Reimbursement Policies Feb 1, 2021

Treatment Rooms with Office Evaluation and Management Services (Facility)

Material Adverse Change (MAC) Notification
February 2021 Empire Provider News Reimbursement Policies Feb 1, 2021

Multiple Diagnostic Imaging procedures (Professional)

Material Adverse Change (MAC) Notification
January 2021 Empire Provider News Reimbursement Policies Jan 1, 2021

Frequency Editing (Professional)

Material Adverse Change (MAC) Notification
January 2021 Empire Provider News Reimbursement Policies Jan 1, 2021

Guidelines for reporting timed units for Physical Medicine and Rehabilitation (Professional)

Material Adverse Change (MAC) Notification
January 2021 Empire Provider News Reimbursement Policies Jan 1, 2021

Modifier Rules (Professional)

Material Adverse Change (MAC) Notification
January 2021 Empire Provider News Reimbursement Policies Jan 1, 2021

Unit Frequency Maximum for Drugs and Biologicals (Professional)

Material Adverse Change (MAC) Notification
January 2021 Empire Provider News Reimbursement Policies Jan 1, 2021

Reimbursement Policy Update: Emergency Department: Leveling of Evaluation and Management Services (Facility)

Material Adverse Change
October 2020 Empire Provider News Reimbursement Policies Oct 1, 2020

Evaluation and Management changes 2021

January 2021 Empire Provider News Reimbursement Policies Jan 1, 2021

Reimbursement Policy Update: Laboratory and Venipuncture (Professional)

Material Adverse Change
October 2020 Empire Provider News Reimbursement Policies Oct 1, 2020

Reimbursement policy update: Frequency editing (Professional)

May 2021 Newsletter Reimbursement Policies May 1, 2021

Reimbursement Policy Updates

October 2018 Empire Provider Newsletter Reimbursement Policies Oct 1, 2018

Reimbursement Policy Update - Drug Screen Testing (Professional)

May 2019 Empire Provider Newsletter Reimbursement Policies May 1, 2019

Reimbursement Policy Update - Readmissions (Facility)

October 2018 Empire Provider Newsletter Reimbursement Policies Oct 1, 2018

New Reimbursement Policy - Facility Revenue Code Billing (Facility)

October 2018 Empire Provider Newsletter Reimbursement Policies Oct 1, 2018

New Reimbursement Policy - Partial Hospitalization Program and Intensive Outpatient Program Services Facility

April 2019 Empire Provider Newsletter Reimbursement Policies Apr 1, 2019

New Reimbursement Policy - Maternity Services and Multiple Delivery - Professional

September 2019 Empire Provider News Reimbursement Policies Sep 1, 2019

New Reimbursement Policy - Intensity Modulated Radiation Therapy Planning and Delivery - Professional

September 2019 Empire Provider News Reimbursement Policies Sep 1, 2019

Claim editing update for Excludes1 notes

September 2019 Empire Provider News Reimbursement Policies Sep 1, 2019

Reimbursement Policy Updates

August 2019 Empire Provider News Reimbursement Policies Aug 1, 2019

Update regarding Evaluation and Management with modifier 25 same day as procedure when a prior E/M for the same or similar service has occurred (Professional)

August 2019 Empire Provider News Reimbursement Policies Aug 1, 2019

Documentation Standards for Episodes of Care (Professional)

Material Adverse Change (MAC) notification
November 2020 Empire Provider News Reimbursement Policies Nov 1, 2020

Modifier Rules (Professional)

Material Adverse Change (MAC) notification
November 2020 Empire Provider News Reimbursement Policies Nov 1, 2020

Bundled Services and Supplies (Professional)

Material Adverse Change (MAC) notification
November 2020 Empire Provider News Reimbursement Policies Nov 1, 2020

Reimbursement Policy Updates

December 2018 Empire Provider Newsletter Reimbursement Policies Dec 1, 2018

Reimbursement for Convenience Surgical Supply Kits - Professional

December 2018 Empire Provider Newsletter Reimbursement Policies Dec 1, 2018

Bundled Services and Supplies - Professional

December 2018 Empire Provider Newsletter Reimbursement Policies Dec 1, 2018

Reimbursement Policy Update - Scope of License (Professional)

December 2018 Empire Provider Newsletter Reimbursement Policies Dec 1, 2018

Claims editing update for ICD-10-CM Excludes 1 notes

April 2021 Newsletter Reimbursement Policies Apr 1, 2021

Let’s Vaccinate

Help increase your vaccination rates and close gaps-in-care with these tools and strategies.
June 2021 Newsletter Products & Programs Jun 1, 2021

Expansion of AIM Musculoskeletal Program effective November 1, 2020

August 2020 Empire Provider News Products & Programs Aug 1, 2020

Update to claim processing for services requiring AIM prior authorization

June 2018 Empire Provider Newsletter Products & Programs May 30, 2018

Updates to AIM Musculoskeletal Program Clinical Appropriateness Guidelines

June 2018 Empire Provider Newsletter Products & Programs May 30, 2018

Coverage Guideline not implemented - Cervical Cancer Screening Using Cytology and Human Papillomavirus Testing (CG-MED-53)

June 2018 Empire Provider Newsletter Products & Programs May 30, 2018

Verifying eligibility for expanded hospice benefits

June 2018 Empire Provider Newsletter Products & Programs May 30, 2018

Empire’s Individualized Care Program to support palliative care for commercial members

June 2018 Empire Provider Newsletter Products & Programs May 30, 2018

Empire CRA Program Update: Medical chart collection for ACA members due March 31, 2019 at the latest

March 2019 Empire Provider Newsletter Products & Programs Mar 1, 2019

Level of Care medical necessity reviews for upper and lower endoscopy procedures begin July 1, 2020

April 2020 Empire Provider News Products & Programs Apr 1, 2020

Blue Precision program to be retired at the end of the year

July 2021 Newsletter Products & Programs Jul 1, 2021

Update: Site of Care medical necessity reviews for long-acting colony-stimulating factors will not be implemented on August 1, 2021

Material adverse change (MAC) notification

July 2021 Newsletter Products & Programs Jul 1, 2021

AIM Rehabilitative program - initial evaluations and site of service reviews

July 2021 Newsletter Products & Programs Jul 1, 2021

REMINDER: New AIM Rehabilitative Program effective November 1, 2019

December 2019 Empire Provider News Products & Programs Dec 1, 2019

Specialty Pharmacy Program expands Level of Care Reviews to NYC Hospital PPO Members

December 2019 Empire Provider News Products & Programs Dec 1, 2019

Case Management Program

December 2019 Empire Provider News Products & Programs Dec 1, 2019

Site of Care medical necessity reviews for long-acting colony-stimulating factors begin June 1, 2021

Material Adverse Change (MAC) Notification
March 2021 Empire Provider News Products & Programs Mar 1, 2021

Reminder and update: new Rehabilitative Program effective July 1, 2019

June 2019 Empire Provider Newsletter Products & Programs Jun 1, 2019

AIM programs may require additional prior authorization documentation

June 2019 Empire Provider Newsletter Products & Programs Jun 1, 2019

Update: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and Setting determinations

July 2020 Empire Provider News Products & Programs Jul 1, 2020

Reminder about AIM’s new Rehabilitative Program effective November 1, 2019

November 2019 Empire Provider News Products & Programs Nov 1, 2019

UPDATE: New AIM Rehabilitative Program will begin November 1, 2019

October 2019 Empire Provider News Products & Programs Oct 1, 2019

AIM IVR changes for non-oncology medical specialty drug reviews effective on January 1, 2021

December 2020 Empire Provider News Products & Programs Dec 1, 2020

Site of Care medical necessity reviews for a wide range of surgical procedures beginning January 1, 2021

Material Adverse Change
October 2020 Empire Provider News Products & Programs Oct 1, 2020

Modification to voluntary Cancer Care Quality Program (CCQP) enhanced reimbursement to begin July 1, 2021

May 2021 Newsletter Products & Programs May 1, 2021

REMINDER: Expansion of AIM Musculoskeletal Program Effective November 1, 2020

October 2020 Empire Provider News Products & Programs Oct 1, 2020

Reminder of New Referral Process

April 2019 Empire Provider Newsletter Products & Programs Apr 1, 2019

New AIM Rehabilitative program effective July 1, 2019

April 2019 Empire Provider Newsletter Products & Programs Apr 1, 2019

UPDATE: New Rehabilitative Program now effective August 1, 2019

Important Update from Empire Products & Programs Jul 3, 2019

UPDATE: new Rehabilitative Program remains temporarily delayed

UPDATE: new Rehabilitative Program remains temporarily delayed Products & Programs Jul 16, 2019

Reminder: Specialty Pharmacy Program expands Level of Care Reviews to NYC Hospital PPO Members

Material Adverse Change (MAC) notification
November 2020 Empire Provider News Products & Programs Nov 1, 2020

Update: Site of Care medical necessity reviews for long-acting colony-stimulating factors begin August 1, 2021

Material adverse change (MAC) notification
April 2021 Newsletter Products & Programs Apr 1, 2021

Interactive bilingual website acting for our health

Exclusively developed for the latino community.
April 2021 Newsletter Products & Programs Apr 1, 2021

Update to AIM Radiation Oncology Clinical Appropriateness Guidelines

August 2018 Empire Provider Newsletter Products & Programs Aug 1, 2018

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines

August 2018 Empire Provider Newsletter Products & Programs Aug 1, 2018

Updates to AIM Level of Care Musculoskeletal Surgery Clinical Appropriateness Guidelines

August 2018 Empire Provider Newsletter Products & Programs Aug 1, 2018

New Musculoskeletal and Pain Management Solution Effective for Select National ASO Accounts January 1, 2020

January 2020 Empire Provider News Products & Programs Jan 1, 2020

Policy Updates

August 2018 Empire Provider Newsletter Policy Updates Aug 1, 2018

Important Update: Milliman Care Guideline (MCG), 23rd Edition, ORG: W0163 Pelvic Organ Prolapse Repair

January 2020 Empire Provider News Policy Updates Jan 1, 2020

Policy Updates

June 2018 Empire Provider Newsletter Policy Updates May 30, 2018

Clinical Guideline (CG-ANC-07) effective July 1, 2019

June 2019 Empire Provider Newsletter Policy Updates Jun 1, 2019
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