New York
Provider Communications

August 2018 Empire Provider Newsletter

Download as PDF

Title Category

Additional Support Available for Members with Rare Conditions

Administrative

Archived medical policy

Medical Policy & Clinical Guidelines

Attention: Updated or New Fee Schedules for Commercial products

Administrative

Clinical Guideline Updates

Medical Policy & Clinical Guidelines

CMS issues regulatory changes for short- and long-acting narcotics; days’ supply limits effective Jan. 1, 2019

Medicare

Coding Spotlight - Obesity

Medicaid

DME providers and physicians: important wheelchair prior authorization information

Medicare

Electronic Data Interchange migration to Availity

Medicaid

Empire accepts prior authorization requests for prescription medications online

Pharmacy

Empire applies daily morphine equivalent dosing limit

Pharmacy

Empire engages with Alliant Health Solutions

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 removes drugs from specialty pharmacy clinical site of care

Pharmacy

Empire to enhance automated claim edits for professional claims

Administrative

Empire to update drug lists supporting commercial health plans

Pharmacy

Empire transitioning to Availity EDI Gateway

Administrative

Home- and community-based services for Health and Recovery Plan beneficiaries

Medicaid

Important billing update for professional delivery claims

Administrative

Important information about billing colonoscopy and related anesthesia services

Administrative

Important information about utilization management

Medicaid

Keep up with Medicare news

Medicare

MA members receive incentives for completing screenings

Medicare

Making a change for the better - FEP system migration information

Federal Employee Plan (FEP)

Medical Policy Updates

Medical Policy & Clinical Guidelines

Member Explanation of Benefits gets a makeover

Administrative

Member’s Rights and Responsibilities Statement

Medicaid

MyDiversePatients.com addresses health care disparities

Medicare

MyDiversePatients.com: A website to support your diverse patients

Administrative

New Eating Disorder Service Available to Empire Members

Behavioral Health

New HEDIS/QARR measures for 2018

Medicaid

New precertification requirement for EGD services begins November 1, 2018

Administrative

New pregnancy notification process using the Availity Portal Benefit Look-Up tool

Medicaid

New pregnancy notification process using the Availity Web Portal Benefit Look-up Tool

Administrative

Normal newborn diagnosis-related group claims processing update

Medicaid

Online Authorizations through the Availity Portal on Interactive Care Reviewer

Administrative

Pharmacy information available on empireblue.com

Pharmacy

Policy Updates

Policy Updates

Prior authorization requirements for Cabazitaxel (Jevtana)

Medicaid

Prior authorization requirements for injectable/infusible drugs: mepolizumab (Nucala) and reslizumab (Cinqair)

Medicaid

Provider Transparency Update

Administrative

Reimbursement Policy Update: Medical Recalls

Medicaid

Reimbursement Policy Updates

Reimbursement Policies

Review medical policy and clinical guidelines when referring services to a facility

Medical Policy & Clinical Guidelines

Submit PA medication requests electronically; new phone number for MA prescription PAs effective Sept. 1

Medicare

Update to AIM Radiation Oncology Clinical Appropriateness Guidelines

Products & Programs

Update to Venipuncture Services Medical Policy effective March 1, 2018

Medical Policy & Clinical Guidelines

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines

Products & Programs

Updates to AIM Level of Care Musculoskeletal Surgery Clinical Appropriateness Guidelines

Products & Programs

Vaginal Birth after Cesarean (VBAC) Certified Shared Decision Making Aid Available on the Web

Administrative

Webinar: Introduction to Availity EDI Gateway services for Empire provider organizations

Administrative
Page 1 of 1