New York
Provider Communications

January 2021 Empire Provider News

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Title Category

2020 Medicare risk adjustment provider trainings

Medicare

2021 FEP® Benefit information available online

Federal Employee Plan (FEP)

Availity Attachment tools for Empire and affiliate payers – Live webinars

Administrative

Clinical Criteria updates for specialty pharmacy are available

Material Adverse Change (MAC) Notification
Pharmacy

Coding spotlight: HEDIS MY 2021

Medicaid

Disease Management/Population Health program

Medicaid

Empire's new digital online scheduling feature is now available

Administrative

Evaluation and Management changes 2021

Reimbursement Policies

FDA approvals and expedited pathways used — new molecular entities (NMEs)

Medicaid

Find out in seconds why your claim denied

Administrative

Frequency Editing (Professional)

Material Adverse Change (MAC) Notification
Reimbursement Policies

Guidelines for reporting timed units for Physical Medicine and Rehabilitation (Professional)

Material Adverse Change (MAC) Notification
Reimbursement Policies

IngenioRx introduces new pharmacy network in 2021

Pharmacy

It is almost CAHPS survey time

Administrative

Keep up with Medicaid news

Medicaid

Keep up with Medicare news

Medicare

MCG Care Guidelines 24th edition customization

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

Medical drug benefit Clinical Criteria updates

Medicaid

Medical drug benefit Clinical Criteria updates

Medicare

Medical Policy updates

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

Modifier Rules (Professional)

Material Adverse Change (MAC) Notification
Reimbursement Policies

Multiple Diagnostic Imaging procedures (Professional)

Material Adverse Change (MAC) Notification
Reimbursement Policies

New features added to Interactive Care Reviewer

Administrative

Outpatient system updates for 2021 (Facility)

Administrative

Prior Authorization updates for specialty pharmacy are available

Material Adverse Change (MAC) Notification
Pharmacy

Professional system updates for 2021

Administrative

Self-service, digital transactions are fast and easy

Administrative

Unit Frequency Maximum for Drugs and Biologicals (Professional)

Material Adverse Change (MAC) Notification
Reimbursement Policies

Updates to AIM Clinical Appropriateness Guidelines for Advanced Imaging

Medicaid

Updates to AIM Clinical Appropriateness Guidelines for Advanced Imaging

Medicare
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