New York
Provider Communications

June 2018 Empire Provider Newsletter

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Title Category

Availity is now our designated EDI Gateway

Administrative

Behavioral health Discharge Action Plan: improving care transitions

Medicaid

Behavioral health network provider training

Medicaid

Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service

Medicaid

Clinical Guideline Updates

Medical Policy & Clinical Guidelines

Coding Spotlight: Pregnancy, A provider’s guide to diagnose and code for pregnancy

Medicaid

Cologuard covered for Medicare Advantage

Medicare

Complex Case Management program

Medicaid

Connecticut Teachers’ Retirement Board Offers Medicare Advantage Option

Medicare

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

Products & Programs

Electrical stimulation device to require prior authorization

Medicaid

Empire Adopts MCG Care Guidelines for Behavioral Health Services

Behavioral Health

Empire expands Specialty Pharmacy Clinical Site of Care (Level of Care) drug list

Pharmacy

Empire expands specialty pharmacy prior authorization list

Pharmacy

Empire streamlines member identification cards

Administrative

Empire to conduct post-payment reviews of distinct procedural services modifiers

Medicaid

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

Products & Programs

Important Update: June 15, 2018 - Access to the Empire Facility / Professional Secure Portals Only on the Availity Portal

Administrative

Introducing Interactive Care Reviewer for Online Authorizations

Administrative

Keep up with Medicare news

Medicare

Lower extremity vascular intervention codes require prior authorization

Medicaid

MA home health network to be delegated to myNEXUS

Medicare

Making a change for the better - FEP® system migration information

Federal Employee Plan (FEP)

Medical Policies and Clinical Utilization Management Guidelines update

Medicaid

Medical Policy Updates

Medical Policy & Clinical Guidelines

Medication adherence incentive offered to EPHC providers

Medicare

Miscellaneous durable medical equipment billing guidelines

Medicaid

Motion Picture Industry Pension and Health Plans Offers Medicare Advantage Option

Medicare

Outpatient visits

Behavioral Health

Peer-to-peer process can help clarify clinical record

Medicare

Pharmacy information available on empireblue.com/provider

Pharmacy

Policy Updates

Policy Updates

Prior authorization requirement update for Mylotarg (gemtuzumab ozogamicin)

Medicaid

Prior authorization requirements for Darzalex (daratumumab) drug

Medicaid

Professional Reimbursement Policy Update

Reimbursement Policies

Provider surveys

Medicaid

Receive Direct Deposit of Patient Payments with Healthcare Bill Payments

Administrative

Reimbursement Policy Reminder - Durable Medical Equipment (Professional)

Reimbursement Policies

Reminder: Empire accepts prior authorization requests for prescription medications online

Pharmacy

Reminder: Miscellaneous durable medical equipment billing guideline:

Administrative

Services requiring prior authorization

Medicaid

Update to claim processing for services requiring AIM prior authorization

Products & Programs

Updated Provider Manual now available

Administrative

Updates to AIM Musculoskeletal Program Clinical Appropriateness Guidelines

Products & Programs

Use the Provider Maintenance Form to update your information

Medicaid

Verifying eligibility for expanded hospice benefits

Products & Programs

What Matters Most: Improving the Patient Experience

Medicaid
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