New York
Provider Communications

August 2019 Empire Provider News

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Title Category

AIM Specialty Health programs may require documentation

Medicaid

Clinical Criteria and Prior Authorization updates for specialty pharmacy are available

Pharmacy

Empire customization's to MCG care guidelines 23rd edition

Administrative

Keep up with Medicaid news

Medicaid

Keep up with Medicare news

Medicare

Medicare Advantage: AIM Specialty Health programs may require documentation

Medicare

Medicare Advantage: New Reimbursement Policy: Drug Screen Testing (Policy 19-001, effective 10/01/19)

Medicare

Medicare Advantage: New service types added to Availity

Medicare

Medicare Advantage: Special needs plans - provider training required

Medicare

New online Provider Manual page

Administrative

Pharmacy information available on empireblue.com

Pharmacy

Pharmacy management information

Medicaid

Policy updates

Medical Policy & Clinical Guidelines

Prepayment clinical validation review process

Medicaid

Reimbursement Policy Updates

Reimbursement Policies

Reminder: Changes to the process for Medical Non-Oncology Specialty Drug reviews effective June 15, 2019

Pharmacy

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 (Professional)

Reimbursement Policies

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

Updates to AIM Advanced Oncologic Imaging Clinical Appropriateness Guideline

Medical Policy & Clinical Guidelines

Updates to AIM Radiation Oncology: Proton Beam Therapy Clinical Appropriateness Guideline

Medical Policy & Clinical Guidelines

Use the Provider Maintenance Form to update your information

Medicaid
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