New York
Provider Communications

February 2019 Empire Provider Newsletter

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Title Category

Empire to enhance claim edits for outpatient facility claims

Administrative

Clinical practice and preventive health guidelines available online

Administrative

HEDIS 2019 Federal Employee Program medical record request requirements

Federal Employee Plan (FEP)

New specialty pharmacy medical step therapy requirements

Medicaid

Introducing a new clinical criteria web page for injectable, infused or implanted drugs covered under the medical benefit

Medicaid

Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service

Medicaid

Diabetes Coding

Medicaid

New and adopted clinical guidelines effective May 1, 2019

Medical Policy & Clinical Guidelines

Un-adopted clinical guidelines effective February 1, 2019

Medical Policy & Clinical Guidelines

Update to AIM Musculoskeletal Program Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

Reminder - Empire follows Original Medicare policies

Medicare

Use grouped CPT codes for AIM Specialty Health authorizations

Medicare

Empire eye refraction and routine eye exam billing information

Medicare

New specialty Medicare Part B device preferred product program

Medicare

Keep up with Medicare news

Medicare

Empire expands specialty pharmacy medical step therapy drug list

Pharmacy

Empire expands specialty pharmacy prior authorization list

Pharmacy

Clinical criteria updates for specialty pharmacy

Pharmacy

Pharmacy information available on empireblue.com

Pharmacy

Injectable Substances with Related Injection Services - (Professional)

Reimbursement Policies

Body Mass Index (BMI) - Facility

Reimbursement Policies

Reminder Review ICD-10-CM Coding Guidelines - Professional

Reimbursement Policies
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