New York
Provider Communications

October 2020 Empire Provider News

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Keep up with important news from Empire and receive notifications by email

Administrative

New Digital Provider Enrollment tool added to Availity for New York

Administrative

New Blue HPN® network included in plans available for employee open enrollment Fall 2020

Administrative

Charges for Personal Protective Equipment by Participating Providers

Administrative

Electronic member ID cards available on the Availity Portal

Administrative

Empire Chat: A fast, easy way to have your questions answered

Administrative

Interactive Care Reviewer adds outpatient medical authorization requests for Empire local, State and City plans

Administrative

Request referrals for Empire Individual Network Plan through Interactive Care Reviewer

Administrative

New Medical Claim Attachment Webinars: Register Today

Administrative

National Accounts 2021 Pre-certification list

Administrative

CRA Reporting Update: New guidance on telephone-only service CPT codes for Risk Adjustment Program

Administrative

What Matters Most: Improving the Patient Experience

Administrative

Federal Employee Program® Expands Specialty Pharmacy Prior Authorization List

Material Adverse Change
Federal Employee Plan (FEP)

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

Medicaid

SOMOS to manage delegated functions effective October 1, 2020

Medicaid

Prior authorization requirements for E0482

Medicaid

Asthma controller medications

Medicaid

Patient360 enhancement for medical providers

Medicaid

Coding spotlight: providers guide to coding for behavioral health disorders

Medicaid

Keep up with Medicaid news

Medicaid

Medical Policy & Clinical Guideline updates

Material Adverse Changes
Medical Policy & Clinical Guidelines

Clinical Criteria updates for specialty pharmacy are available

Material Adverse Change
Medical Policy & Clinical Guidelines

Transition to AIM Rehabilitative Service Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

Prior authorization requirements for the below codes (December 1, 2020)

Medicare

Prior authorization requirements for the below codes (January 1, 2021)

Medicare

Patient360 enhancement for medical providers

Medicare

Social determinants of health support expanding with GroundGame Health

Medicare

Evaluation and management services correct coding

Medicare

Provider transparency update

Medicare

Medical drug benefit Clinical Criteria updates

Medicare

Keep up with Medicare news

Medicare

Empire updates formulary lists for commercial health plan pharmacy benefit

Pharmacy

Designated Specialty Pharmacies in 2021

Material Adverse Change
Pharmacy

National Drug Code requirement on outpatient claims

Material Adverse Change
Pharmacy

Prior authorization updates for specialty pharmacy are available

Pharmacy

Updated Coverage for Breast Cancer prevention medications

Pharmacy

FDA approvals and expedited pathways used - New Molecular Entities (NMEs)

Pharmacy

Pharmacy information available on empireblue.com

Pharmacy

Site of Care medical necessity reviews for a wide range of surgical procedures beginning January 1, 2021

Material Adverse Change
Products & Programs

REMINDER: Expansion of AIM Musculoskeletal Program Effective November 1, 2020

Products & Programs

Reimbursement Policy Update: Emergency Department: Leveling of Evaluation and Management Services (Facility)

Material Adverse Change
Reimbursement Policies

Reimbursement Policy Update: Laboratory and Venipuncture (Professional)

Material Adverse Change
Reimbursement Policies
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