New York
Provider Communications

November 2020 Empire Provider News

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Title Category

AIM rehabilitation prior authorizations suspended for Group Retiree Solutions members until December 31, 2020

Medicare

Aspire Health telehealth palliative care program for Medicaid members in need of telephonic palliative care

Medicaid

Attention: Updated laboratory fee schedule

Medicaid

Availity Attachment Tools for Empire and Affiliate Payers – Live Webinars

Administrative

Bundled Services and Supplies (Professional)

Material Adverse Change (MAC) notification
Reimbursement Policies

Clinical Criteria updates for specialty pharmacy are available

Material Adverse Change (MAC) notification
Pharmacy

Clinical Guideline Updates

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

Clinical Laboratory Improvement Amendments (CLIA) Number – Additional Information

Administrative

Coding spotlight: tips and best practices for compliance

Medicaid

Digital transactions cut administrative tasks in half

Administrative

Digital transactions cut administrative tasks in half

Medicaid

Documentation Standards for Episodes of Care (Professional)

Material Adverse Change (MAC) notification
Reimbursement Policies

FDA approvals and expedited pathways used — new molecular entities

Medicare

Get the full picture of your patient’s health through their smartphone

Administrative

IngenioRx Introduces New Pharmacy Network in 2021

Pharmacy

Inhaled nitric oxide reviews for diagnosis-related group admissions

Medicaid

Keep up with Medicaid news

Medicaid

Keep up with Medicare news

Medicare

Medical drug benefit Clinical Criteria updates

Medicaid

Medical drug benefit Clinical Criteria updates

Medicare

Modifier Rules (Professional)

Material Adverse Change (MAC) notification
Reimbursement Policies

New specialty pharmacy medical step therapy requirements (Avastin)

Medicaid

New specialty pharmacy medical step therapy requirements (Herceptin)

Medicaid

Preferred continuous glucose monitors

Medicare

Prior authorization updates for specialty pharmacy are available

Material Adverse Change (MAC) notification
Pharmacy

Provider Chat — A fast, easy way to get your questions answered

Medicare

Provider transparency update

Medicaid

Reimbursement Policy: Nurse Practitioner and Physician Assistant Services (Professional)

Medicaid

Reminder: Post-service reviews using AIM

Medical Policy & Clinical Guidelines

Reminder: Specialty Pharmacy Program expands Level of Care Reviews to NYC Hospital PPO Members

Material Adverse Change (MAC) notification
Products & Programs

Transition to AIM Rehabilitative Service Clinical Appropriateness Guidelines

Medicaid

Transition to AIM Rehabilitative Service Clinical Appropriateness Guidelines

Medicare

Update: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and setting determinations

Medicaid

US Antibiotic Awareness Week

Administrative
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