New York
Provider Communications

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Clinical appeals

Provider claim payment disputes for Empire’s Commercial lines of business

Good news! Non-payment remittance advice enhancements coming soon

REMINDER: EnrollSafe, the new electronic funds transfer enrollment portal for Empire providers – replacing CAQH Enrollhub effective November 1, 2021

Procedure searches in Find Care

Clinical Criteria updates for specialty pharmacy

Designated specialty pharmacy network updates effective January 1, 2022

Material adverse change (MAC) notification

Specialty pharmacy updates - October 2021

Pharmacy information available on empireblue.com

Medical policy and clinical guideline updates

Material adverse change (MAC) notification

Get your payments faster when you sign up for electronic funds transfer

Diabetes testing and screening HEDIS measures

New Reimbursement Policy: Sexually Transmitted Infections Testing (Professional)

FAQ: Update to AIM phone number

Prior authorization updates for specialty pharmacy IV

Prior authorization updates for specialty pharmacy V

Keep up with Medicaid news - October 2021

• 2021 affirmative statement concerning utilization management decisions
• May 2021 Medical Policies and Utilization Management Guidelines update

Webinars for City of New York retirees transitioning to new Medicare Advantage plan

Get your payments faster when you sign up for electronic funds transfer

Information about 2021 Special Needs Plans

HEDIS® medical record submission made easier with our Remote EMR Access Service

New Reimbursement Policy: Sexually Transmitted Infections Testing (Professional)

New Medical Step Therapy Requirements

Keep up with Medicare news - October 2021

• 2021 affirmative statement concerning utilization management decisions
• May 2021 Medical Policies and Utilization Management Guidelines update

Register today for the Exploring the Impact of Racial Trauma on the Health & Wellbeing of Children forum on September 29, 2021

Join us to hear from a diverse panel of experienced Motivo and Empire professionals about the impact of racial trauma on the health and wellbeing on children and adolescents.

Register now for our September CME webinars!

Statin therapy for patients with diabetes

6 SIMPLE strategies to help increase medication adherence

Cure for the common cold: rest, fluids and this free prescription pad

Be Antibiotic Aware campaign offers a prescription solution to antibiotics

National Accounts 2022 Pre-certification list

HEDIS® medical record submission made easier with our Remote EMR Access Service

Get your payments faster when you sign up for electronic funds transfer

Introducing EnrollSafe, the new electronic funds transfer enrollment portal for Empire providers - replacing CAQH Enrollhub effective November 1, 2021.

Updates for specialty pharmacy are available - September 2021

Material adverse change (MAC) notification

Clinical Criteria updates for specialty pharmacy

Reimbursement policy update: Sexually Transmitted Infections Testing (Professional)

Material adverse change (MAC) notification

Reimbursement policy update: Drug Screen Testing (Professional)

Reimbursement policy reminder Professional Anesthesia Services (Professional)

Federal Employee Program® AIM Radiology prior authorization review transition delayed until November

Material adverse change (MAC) notification

Keep up with Medicaid news - September 2021

• Clinical Criteria Updates Notification May 2021
• Iron Infusion Step Therapy
• Iron Infusion Prior Authorization Update

City of New York Offers NYC Medicare Advantage Plus Medicare Advantage Option

Reimbursement Policy Update: DRG Inpatient Facility Transfers (Effective 11/30/21)

Utilization management authorization rule operations

Prior authorization/Precertification form notification

Keep up with Medicare news - September 2021

• Clinical Criteria Updates Notification May 2021

2021 Provider Manual now available

Telehealth visits can impact after-hospitalization follow-up care for mental illness

Clearing up coding confusion for retinal eye exams (DRE)

Register now for our August CME webinars

Digital scheduling feature in the Availity Portal: the Appointment Scheduler application

Specialty dose rounding program for certain oncology medications

Specialty dose rounding program for certain non-oncology medications beginning August 1, 2021

Immune globulin adjusted body weight dosing program beginning August 1, 2021

Clinical criteria updates for specialty pharmacy

Material adverse change (MAC) notification

Empire to update formulary lists for commercial health plan pharmacy benefit

Updates for specialty pharmacy effective November 1, 2021

Pharmacy information available on empireblue.com

Transition to AIM Specialty Health Imaging of the Heart clinical appropriateness guideline for Computed Tomography to detect coronary artery calcification

Medical policy and clinical guideline updates

Inpatient Readmission (Facility)

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

Virtual Visits - Professional and Facility

Material adverse change (MAC) notification

Change in email submission of service requests for Federal Employee Program members

Keep up with Medicaid news

City of New York offers Medicare Advantage option in 2022

Preventing claims denials: Shingles vaccine

Policy reminder: Inpatient Readmissions

Keep up with Medicare news

Register for upcoming August CME webinars

Motivating Patients to Adhere to Cervical Cancer Prevention and Screening Recommendations
Tuesday, August 3, 2021, 12:00 p.m. ET


10 Best Practices for Improving Pharmacy Quality Measures
Thursday, August 12, 2021, 1:00 p.m. or 3:00 p.m. ET


6 Ways to Improve Risk Adjustment Documentation Accuracy
Tuesday, August 17, 2021, 12:00 p.m. or 3:00 p.m. ET


Register Now!

Surgical Clinical Site of Care review updates

Proper coding for in-home monitoring can make a measurable difference for INR

Another mark of the pandemic: an increase in childhood obesity

Timely receipt of primary payer’s EOB can help reduce timely filing denials for secondary claims

Register now to learn strategies to help you and your practice improve clinical quality

Commercial Repapering: Important update

How to enroll in electronic fund transfer (EFT) for faster remittance

Electronic claim response files

Interactive Care Reviewer (ICR): New search option for cases submitted through ICR

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

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

AIM Rehabilitative program - initial evaluations and site of service reviews

Certain specialty medication precertification requests may require additional documentation

Clinical Criteria updates for specialty pharmacy

Updates for specialty pharmacy are effective October 1, 2021

Designated specialty pharmacy network updates effective October 1, 2021

Medical policy updates and clinical guideline updates

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

Reimbursement policy update: Consultations (Professional)

Federal Employee Program® AIM Radiology prior authorization review

Attention facilities: Sending admission, discharge and transfer data to Empire results in improved care management for patients

Let’s Vaccinate

New reimbursement policy: Modifier 90: Reference (Outside) Laboratory and Pass-Through Billing (Effective 10/01/21)

Prior authorization requirement changes effective September 1, 2021

Certain specialty medication precertification requests may require additional documentation

Medical drug benefit Clinical Criteria updates

Retraction: AIM Rehabilitative program — initial evaluations and site of service reviews

Updates to AIM Specialty Health Musculoskeletal program clinical appropriateness guidelines

Coding spotlight: mental disorders in childhood

What Matters Most: Improving the Patient Experience

Resources to support your diverse patient panel