New York
Provider Communications

April 2019 Empire Provider Newsletter

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Title Category

Clinical Criteria updates

Medicaid

Clinical practice and preventive health guidelines available online

Administrative

Coming soon: Reimbursement for select HEDIS-related CPT II codes for Medicare Advantage members

Medicare

Correction: Cervical length measurement by transvaginal ultrasound

Medicaid

Empire CRA Reporting Update: Accurate coding helps provide a comprehensive picture of patients’ health and services provided

Administrative

Empire expands specialty pharmacy prior authorization list

Pharmacy

Help prevent preeclampsia with prenatal aspirin

Medicaid

Keep up with Medicare news

Medicare

Medical necessity review for appropriate level of care

Medicaid

Medical Policies and Clinical Utilization Management Guidelines update

Medicaid

Medical Policy and Clinical Guideline Updates

Medical Policy & Clinical Guidelines

New AIM Rehabilitative program effective July 1, 2019

Products & Programs

New on Interactive Care Reviewer: Request Clinical Appeals

Administrative

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

Reimbursement Policies

Online registration processes for electronic funds transfers and electronic remittance advices

Medicare

Online registration processes for electronic funds transfers and electronic remittance advices

Medicaid

Pharmacy information available on empireblue.com

Pharmacy

Practitioners’ rights during credentialing process

Medicaid

Provider surveys

Medicaid

Reminder of New Referral Process

Products & Programs

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

Medicare

Update to AIM Advanced Imaging of the Head and Neck Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

Update to AIM Advanced Imaging of the Heart Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

Update to AIM Musculoskeletal Joint Surgery Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

Update to AIM Sleep Disorder Management Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

Why do patients stop taking their prescribed medications and what can you do to help them?

Administrative
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