New York
Provider Communications

December 2020 Empire Provider News

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Title Category

2021 Medicare Advantage individual benefits and formularies

Medicare

Access requirements for behavioral healthcare services

Behavioral Health

Access to claim denial information is now self-service

Administrative

AIM IVR changes for non-oncology medical specialty drug reviews effective on January 1, 2021

Products & Programs

Anthem, Inc. and Quest Diagnostics Form Strategic Relationship

Administrative

Bundled Services and Supplies (Professional)

Reimbursement Policies

CAHPS education for providers

Medicaid

Case Management Program

Administrative

Clinical Criteria updates for specialty pharmacy are available

Material Adverse Change (MAC) Notification
Pharmacy

Clinical practice and preventive health guidelines available on empireblue.com

Administrative

Coordination of Care

Administrative

Digital transactions cut administrative tasks in half

Medicaid

Digital transactions cut administrative tasks in half

Medicare

Empire contracted Air Ambulance providers

Administrative

Empire expands hospice policy

Reimbursement Policies

Empire makes going digital easy with the Provider Digital Engagement Supplement

Administrative

Empire to change ID numbers for Building Service 32BJ Health Fund members

Administrative

Flu vaccination reimbursement

Medicaid

Important Information about Utilization Management

Administrative

Keep up with Medicaid news

Medicaid

Keep up with Medicare news

Medicare

Medical Policies and Clinical Utilization Management Guidelines update

Medicare

Medicare Advantage Group Retiree Member Eligibility, Alpha Prefix FAQ

Medicare

Members’ Rights and Responsibilities

Administrative

New Blue HPN® plans go live January 1, 2021

Administrative

Notifications on the Availity Portal

Medicaid

PCP after-hours access requirements

Administrative

Pharmacy information available on empireblue.com

Pharmacy

Prior authorization updates for commercial business effective March 1, 2021

Administrative

Prior authorization updates for specialty pharmacy - effective March 1, 2021

Material Adverse Change (MAC) Notification
Pharmacy

Reminder: Company requires National Drug Code for professional and facility outpatient claims effective December 11, 2020

Material Adverse Change (MAC) Notification
Pharmacy

Resources to support your pregnant and postpartum patients and their families

Medicaid

Sign up to receive email from Empire BlueCross BlueShield HealthPlus

Medicaid

Transition to AIM Rehabilitative Services Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

Update to reimbursement policy usage

Medicaid

Updates to AIM Advanced Imaging Clinical Appropriateness Guideline

Material Adverse Change (MAC) Notification
Medical Policy & Clinical Guidelines

Updates to AIM Cardiology Clinical Appropriateness Guidelines

Material Adverse Change (MAC) Notification
Medical Policy & Clinical Guidelines

Updates to AIM Radiation Oncology Clinical Appropriateness Guideline

Material Adverse Change (MAC) Notification
Medical Policy & Clinical Guidelines

Videos to engage patients about preventive care available on empireblue.com

Administrative
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