New York
Provider Communications

June 2021 Newsletter

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Title Category

Updates to AIM Musculoskeletal Program Clinical Appropriateness Guidelines

Material adverse change (MAC) notification
Medical Policy & Clinical Guidelines

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines

Material adverse change (MAC) notification
Medical Policy & Clinical Guidelines

Updates for specialty pharmacy effective September 1, 2021

Material adverse change (MAC) notification
Pharmacy

Two great learning resources on One Secure Portal

Digital Tools

Submit EDI corrected claims via Availity or EDI

Digital Tools

Reminders for Medicare Advantage Group Retiree PPO plans and National Access Plus FAQ

Medicare

Regular check-ins with your clearinghouse could affect timely filing

Administrative

Provider education program survey: Your Voice Counts

Medicaid

Physicians and clinical care teams: Imaging for lower back pain does not improve outcomes, study finds

Administrative

Pharmacy information available on empireblue.com

Pharmacy

Members’ Rights and Responsibilities Statement

Medicaid

Medical Policies and Clinical Utilization Management Guidelines update

Medicare

MCG Care Guidelines 25th Edition

Medicaid

MCG Care Guidelines 25th Edition

Medicare

Let’s Vaccinate

Help increase your vaccination rates and close gaps-in-care with these tools and strategies.
Products & Programs

Keeping up with routine vaccination during COVID-19

Medicaid

Keep your contact information current

Administrative

Keep up with Medicare news

Medicare

Keep up with Medicaid news

Medicaid

Interactive Care Reviewer’s new copy feature decreases time to submit authorization request

Digital Tools

Important information about utilization management

Medicaid

Empire to enhance claim edits for Outpatient Facility Claims

Reimbursement Policies

Digital Solution Options with Availity

Digital Tools

DEXA bone scan criteria for the Federal Employee Program

Federal Employee Plan (FEP)

Designated specialty pharmacy network updates

Pharmacy

Complex Case Management program

Medicaid

Clinical Criteria updates for specialty pharmacy

Material adverse change (MAC) notification
Medical Policy & Clinical Guidelines

Aspire Health for members in need of palliative care

Medicaid
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