New York
Provider Communications

December 2018 Empire Provider Newsletter

Download as PDF

Title Category

When and how to initiate Medicare Advantage reopenings

Medicare

Viral suppression rates improve in patients with HIV in the US,while disparities continue to exist

Medicaid

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

Administrative

Updates to AIM Musculoskeletal Surgery Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

UPDATE: Prior authorization requirements for high-level, definitive drug testing delayed

Medicaid

Update to AIM Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

Transition of Outpatient Rehabilitation Utilization Management Program effective January 1, 2019

Medicaid

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

Medical Policy & Clinical Guidelines

Restructure of AIM Advanced Imaging Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

Reimbursement Policy Updates

Reimbursement Policies

Reimbursement Policy Update: Claims Requiring Additional Documentation (Policy 06-031, effective 03/01/19)

Medicaid

Reimbursement Policy Update - Scope of License (Professional)

Reimbursement Policies

Reimbursement for Convenience Surgical Supply Kits - Professional

Reimbursement Policies

Prior authorization requirements for Sublocade

Medicaid

Prior authorization requirements for Subcutaneous Implantable Defibrillator system

Medicaid

Prepare NOW for Empire Facility and Physician Portal Retirement

Administrative

Practitioners’ rights during credentialing process

Medicaid

Policy updates

Policy Updates

Pharmacy management information

Medicaid

Pharmacy information available on empireblue.com

Pharmacy

New Medicare Advantage provider service phone number beginning January 1, 2019

Medicare

Members’ Rights and Responsibilities

Administrative

Medicare Part B drugs may include Step Therapy beginning January 1, 2019

Medicare

Medical Policy Updates

Medical Policy & Clinical Guidelines

Medical Policies updated

Medicare

Medical Policies and Clinical Utilization Management Guidelines update

Medicaid

MediBlue Select HMO Network expands effective January 1, 2019

Medicare

Keep up with Medicare news

Medicare

Introducing the new Clinical Criteria page for injectable, infused or implanted drugs

Pharmacy

Integrated Care Model for plans purchased on the Health Insurance Marketplace benefits patients and physicians

Administrative

Individual Medicare plans move compound drugs off formulary beginning January 1, 2019

Medicare

Important Information about Utilization Management

Administrative

HEDIS® 2018 Commercial Results Are In

Administrative

Explore new enhancements to the Education and Reference Center

Administrative

Empire HealthPlus adopts MCG Care Guidelines for clinical reviews of mental health services

Medicaid

Empire announces changes to the Individual Health Benefit Plans

Administrative

Empire announces a new network - Blue Access

Administrative

Empire accepts electronic prior authorization requests for prescription medications online

Pharmacy

Electronic data interchange gateway update

Medicaid

Coordination of Care

Administrative

Coordination of Benefits for an FEP member

Federal Employee Plan (FEP)

ConditionCare Program Benefits Patients and Physicians

Administrative

Company works to simplify payment recovery process for National Accounts membership

Administrative

Coding spotlight: substance use disorders and smoking

Medicaid

CMS Medicare Preclusion List effective April 1, 2019

Medicare

Clinical practice and preventive health guidelines available online

Administrative

Clinical Guideline Updates

Medical Policy & Clinical Guidelines

Case Management Program

Administrative

Bundled Services and Supplies - Professional

Reimbursement Policies

Benefit change for Infliximab for Federal Employee Program

Federal Employee Plan (FEP)

Availity to serve as EDI entry point for electronic submissions

Administrative

2019 Medicare Advantage individual benefits and formularies

Medicare

2019 FEP Benefit information available online

Federal Employee Plan (FEP)
Page 1 of 1