New York
Provider Communications

April 2021 Newsletter

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Title Category

Updates for specialty pharmacy are available

Material adverse change (MAC) notification
Pharmacy

Updated provider agreement

Administrative

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

Material adverse change (MAC) notification
Products & Programs

Update for commercial providers regarding the AIM Sleep Program CPT Code E1399, NOC: Durable medical equipment, miscellaneous

Medical Policy & Clinical Guidelines

Understanding Availity Roles for Electronic Data Interchange (EDI)

Administrative

The heath of millennials: Trends in behavioral health conditions

Behavioral Health

Submit appeals for clinically denied appeals via ICR

Administrative

State of Connecticut employer group and Connecticut partnership plan

Administrative

Reminder: Site of care medical necessity reviews for a wide range of surgical procedures began January 1, 2021

Administrative

Pharmacy information available on empireblue.com

Pharmacy

Payer Spaces - Education and Reference Center has been replaced by Information Center

Administrative

Oncology dose reduction program beginning July 1, 2021

Medicare

Notify us of telehealth services

Medicare

New utilization management tool now available on Availity Payer Spaces: Authorization Rules Lookup tool

Administrative

Medical policy updates

Material adverse change (MAC) notification
Medical Policy & Clinical Guidelines

Medical drug benefit clinical criteria updates – November 2020

Medicare

Medical drug benefit clinical criteria updates – December 2020

Medicare

MCG Care Guidelines 25th Edition

Medical Policy & Clinical Guidelines

Maximizing efficient, high quality COVID-19 screenings

Administrative

Make the change to digital authorization/referral and hospital admission notifications using EDI

Administrative

Keeping up with routine vaccination during COVID-19: Well-child visits and vaccinations are essential services

Administrative

Keep up with Medicaid news

Medicaid

Join Empire in talking about racism and its impact on health

Administrative

Interactive bilingual website acting for our health

Exclusively developed for the latino community.
Products & Programs

In-office assessment program

Medicare

HEDIS 2021 Federal Employee Program® medical record request requirements

Federal Employee Plan (FEP)

Does your practice offer telehealth services? Let us know!

Administrative

Correction: Updated formulary lists for commercial health plan pharmacy benefit effective April 1, 2021

Pharmacy

Clinical criteria updates for specialty pharmacy

Material adverse change (MAC) notification
Pharmacy

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

Reimbursement Policies

Chat directly with a prior authorization specialist

Administrative

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

Administrative
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