New York
Provider Communications

December 2021 Newsletter

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Title Category

Prepare for the Consolidated Appropriations Act: Keep your provider directory information up to date

Administrative

Facility option to receive verbal UM Notifications electronically

Administrative

Submitting prior authorizations is getting easier

Empire is transitioning to the Availity Authorization app

Administrative

Is prior authorization required?

Answering your questions about the new Availity Authorization app

Administrative

Chlamydia screening for teens and young adults

Administrative

Outpatient system updates for 2022

Administrative

Professional system updates for 2022

Administrative

Clinical practice and preventive health guidelines available on empireblue.com

Administrative

Coordination of care

Administrative

Member rights and responsibilities

Administrative

Important information about utilization management

Administrative

Case management program

Administrative

Importance of PCP after-hours messaging

Administrative

Behavioral healthcare appointment access requirements

Administrative

Reminder: The 32BJ Health Fund Centers of Excellence for Bariatric and Joint Replacement Surgery program begins January 1, 2022

Administrative

Reminder: EnrollSafe is available - electronic funds transfer enrollment portal for Empire providers

EnrollSafe replaced CAQH Enrollhub effective November 1, 2021
Digital Tools

Utilization management tool available on Availity Payer Spaces: Authorization Rules Lookup tool

Digital Tools

Reimbursement policy update: Drug Screen Testing (effective March 1, 2022)

Medicaid

Reimbursement policy update: Multiple and Bilateral Surgery - Professional and Facility (effective 03/01/22)

Medicaid

HEDIS measures: Follow-Up After ED Visits for Mental Illness and Alcohol and Drug Dependency

Medicaid

Claims editing update for ICD-10-CM Excludes1 notes

Medicaid

Updates to AIM Specialty Health Advanced Imaging clinical appropriateness guidelines

Medicaid

Medical Policies and Clinical Utilization Management Guidelines update

Medicaid

Good news: Non-payment remittance advice enhancements are here

Medicaid

Submitting prior authorizations is getting easier

Medicaid

Keep up with Medicaid news - December 2021

View these Medicaid articles:

  • Durable medical equipment prior authorization requirement changes effective December 1, 2021
  • Cancer Care Navigator
  • Medical drug benefit Clinical Criteria updates
  • Prior authorization updates for medications billed under the medical
    benefit
  • Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines
  • Updates to AIM Specialty Health musculoskeletal interventional pain management
    clinical appropriateness guideline
Medicaid

Updates to AIM Specialty Health Musculoskeletal Interventional Pain Management clinical appropriateness guideline

Material Adverse Change (MAC)
Medical Policy & Clinical Guidelines

Updates to AIM Specialty Health Cardiology clinical appropriateness guidelines

Material Adverse Change (MAC)
Medical Policy & Clinical Guidelines

Updates to AIM Specialty Health Radiation Oncology clinical appropriateness guideline

Material Adverse Change (MAC)
Medical Policy & Clinical Guidelines

Updates to AIM Advanced Imaging clinical appropriateness guideline

Material Adverse Change (MAC)
Medical Policy & Clinical Guidelines

City of New York GRS Alliance Program (Updated 12/3/21)

Medicare

Webinars for City of New York retirees transitioning to new Medicare Advantage plan (Updated 12/3/21)

Medicare

Reimbursement Policy Update: Drug Screen Testing (effective March 1, 2022)

Medicare

Updates to AIM Specialty Health Advanced Imaging clinical appropriateness guidelines

Medicare

2022 Medicare Advantage service area and benefit updates

Medicare

Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies

Medicare

Good news: Non-payment remittance advice enhancements are here

Medicare

Submitting prior authorizations is getting easier

Medicare

Keep up with Medicare news - December 2021

View these Medicare articles:

  • Medical drug benefit Clinical Criteria updates
  • FAQ: NYC Medicare Advantage Plus
  • Protocol for providers serving members with hearing aid
    coverage administered by Hearing Care Solutions
  • Medical Policies and Clinical Utilization Management Guidelines update
  • Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines
  • Updates to AIM Specialty Health musculoskeletal interventional pain management
    clinical appropriateness guideline
Medicare

Clinical Criteria updates for specialty pharmacy

Material Adverse Change (MAC)
Pharmacy

Specialty pharmacy updates - December 2021

Material Adverse Change (MAC)
Pharmacy

Pharmacy information available on empireblue.com

Pharmacy

Empire to retire Blue Precision program on December 31, 2021

Products & Programs

Reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) - professional

Material Adverse Change (MAC)

Reimbursement Policies

New reimbursement policy update: Modifier 62: Co-Surgeon Services and Modifier 66: Surgical Teams - professional

Material Adverse Change (MAC)

Reimbursement Policies

Reimbursement policy update: Virtual Visits - professional and facility

Reimbursement Policies
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