New York
Provider Communications

Clinical Criteria updates

Model of Care required training

The impact of listening

Keep up with Medicare news – April 2022

View these Medicare articles:

• Medical Policies and Clinical Utilization Management Guidelines update
• Empire BlueCross BlueShield expands specialty pharmacy precertification list
• AIM Specialty Health Outpatient Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines updates

City of New York Retirees Transition to NYC Medicare Advantage Plus Delayed

The Anthem, Inc. name is changing

Exploring Implicit Bias in Healthcare for Historically Marginalized Communities

Register today for the Exploring Implicit Bias in Healthcare for Historically Marginalized Communities forum hosted by Empire and Motivo* for providers on March 16, 2022

CAA: Have you reviewed your online provider directory information lately?

New! Vaccination resource page for providers

Updated Preventive Care Guidance regarding screening colonoscopies

Your influence matters: recommending cancer screenings to your patients

Understanding your patients’ differences is lifesaving

Simplifying requests for additional information

Enhancements to the Availity Authorization application are now available

Clinical Criteria updates for specialty pharmacy

Correction to February 2022 specialty pharmacy updates

Specialty pharmacy updates – March 2022

AIM Specialty Health Outpatient Rehabilitative and Habilitative Services clinical appropriateness guidelines updates

Change to the Federal Employee Program® Clinical Grievance and Appeal Address

HEDIS 2022 Federal Employee Program® medical record request requirements

Required: Cultural competence training

It is CAHPS survey time!

Urinary tract infection toolkits are on the way

New Strategic Provider System will launch in April 2022

New select plans on our HealthPlus Medicare network

Annual wellness visits for Medicare Advantage members

Medication adherence

Clinical Criteria updates

Provider notification for utilization management authorization rule operations workgroup item 2662

Keep up with Medicare news - March 2022

View these Medicare articles:

• Medical step therapy updates

Prepare for the CAA: Keep your provider directory information current

Heart disease is the number one killer of women

It is CAHPS survey time!

Cancer Care Navigator

Clinical Criteria updates for specialty pharmacy

Material Adverse Change (MAC)

Specialty pharmacy updates - February 2022

Pharmacy information available on empireblue.com

Clarification to reimbursement policy update: Virtual Visits - Professional and Facility

Get faster payments with EFT

Get faster payments with EFT

City of New York Retirees will transition to NYC Medicare Advantage Plus offered through an alliance between Empire and EmblemHealth

Blue High Performance Network name changing for 2022

Well-child visits: Know the numbers

Medical policy and clinical guideline updates

Material Adverse Change (MAC)

2022 FEP® Benefit information available online

Botox update for Empire BlueCross BlueShield HealthPlus members

Reducing the burden of medical record review and improving health outcomes with HEDIS ECDS reporting

2021 CAHPS Survey results

Keep up with Medicaid news - January 2022

View these Medicaid articles:

• AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines
  update
• Prior authorization updates for medications billed under the medical
  benefit

NYC Medicare Advantage Plus effective date change

Important update on Botox® for Medicare members of Empire BlueCross BlueShield

Local 282 Welfare Trust Fund moves to Empire MediBlue Freedom (PPO) Medical plan

Professional claims — billing referring provider and NPI for home infusion therapy and ambulatory infusion suite

Reducing the burden of medical record review and improving health outcomes with HEDIS ECDS reporting

Keep up with Medicare news - January 2022

View these Medicare articles:

• Medical step therapy updates
• Empire BlueCross expands specialty pharmacy precertification list
• AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines
  update

Empire is transitioning to the Availity Authorization App

Availity Authorization App improvements based on your feedback

Prepare for the Consolidated Appropriations Act: Keep your provider directory information up to date

Facility option to receive verbal UM Notifications electronically

Submitting prior authorizations is getting easier

Empire is transitioning to the Availity Authorization app

Is prior authorization required?

Answering your questions about the new Availity Authorization app

Chlamydia screening for teens and young adults

Outpatient system updates for 2022

Professional system updates for 2022

Clinical practice and preventive health guidelines available on empireblue.com

Coordination of care

Member rights and responsibilities

Important information about utilization management

Case management program

Importance of PCP after-hours messaging

Behavioral healthcare appointment access requirements

Reminder: The 32BJ Health Fund Centers of Excellence for Bariatric and Joint Replacement Surgery program begins January 1, 2022

Reminder: EnrollSafe is available - electronic funds transfer enrollment portal for Empire providers

Utilization management tool available on Availity Payer Spaces: Authorization Rules Lookup tool

Empire to retire Blue Precision program on December 31, 2021

Clinical Criteria updates for specialty pharmacy

Specialty pharmacy updates - December 2021

Pharmacy information available on empireblue.com

Updates to AIM Specialty Health Musculoskeletal Interventional Pain Management clinical appropriateness guideline

Updates to AIM Specialty Health Cardiology clinical appropriateness guidelines

Updates to AIM Specialty Health Radiation Oncology clinical appropriateness guideline

Updates to AIM Advanced Imaging clinical appropriateness guideline

Reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) - professional

Material Adverse Change (MAC)

New reimbursement policy update: Modifier 62: Co-Surgeon Services and Modifier 66: Surgical Teams - professional

Material Adverse Change (MAC)

Reimbursement policy update: Virtual Visits - professional and facility

Reimbursement policy update: Drug Screen Testing (effective March 1, 2022)

Reimbursement policy update: Multiple and Bilateral Surgery - Professional and Facility (effective 03/01/22)

HEDIS measures: Follow-Up After ED Visits for Mental Illness and Alcohol and Drug Dependency

Claims editing update for ICD-10-CM Excludes1 notes

Updates to AIM Specialty Health Advanced Imaging clinical appropriateness guidelines

Medical Policies and Clinical Utilization Management Guidelines update

Good news: Non-payment remittance advice enhancements are here

Submitting prior authorizations is getting easier

Keep up with Medicaid news - December 2021

View these Medicaid articles:

• Durable medical equipment prior authorization requirement changes effective December 1, 2021
• Cancer Care Navigator
• Medical drug benefit Clinical Criteria updates
• Prior authorization updates for medications billed under the medical
  benefit
• Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines
• Updates to AIM Specialty Health musculoskeletal interventional pain management
  clinical appropriateness guideline

City of New York GRS Alliance Program (Updated 12/3/21)

Webinars for City of New York retirees transitioning to new Medicare Advantage plan (Updated 12/3/21)

Reimbursement Policy Update: Drug Screen Testing (effective March 1, 2022)

Updates to AIM Specialty Health Advanced Imaging clinical appropriateness guidelines

2022 Medicare Advantage service area and benefit updates

Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies

Good news: Non-payment remittance advice enhancements are here