New York
Provider Communications

Register for upcoming August CME webinars

Motivating Patients to Adhere to Cervical Cancer Prevention and Screening Recommendations
Tuesday, August 3, 2021, 12:00 p.m. ET


10 Best Practices for Improving Pharmacy Quality Measures
Thursday, August 12, 2021, 1:00 p.m. or 3:00 p.m. ET


6 Ways to Improve Risk Adjustment Documentation Accuracy
Tuesday, August 17, 2021, 12:00 p.m. or 3:00 p.m. ET


Register Now!

Surgical Clinical Site of Care review updates

Proper coding for in-home monitoring can make a measurable difference for INR

Another mark of the pandemic: an increase in childhood obesity

Timely receipt of primary payer’s EOB can help reduce timely filing denials for secondary claims

Register now to learn strategies to help you and your practice improve clinical quality

Commercial Repapering: Important update

How to enroll in electronic fund transfer (EFT) for faster remittance

Electronic claim response files

Interactive Care Reviewer (ICR): New search option for cases submitted through ICR

Blue Precision program to be retired at the end of the year

Update: Site of Care medical necessity reviews for long-acting colony-stimulating factors will not be implemented on August 1, 2021

Material adverse change (MAC) notification

AIM Rehabilitative program - initial evaluations and site of service reviews

Certain specialty medication precertification requests may require additional documentation

Clinical Criteria updates for specialty pharmacy

Updates for specialty pharmacy are effective October 1, 2021

Designated specialty pharmacy network updates effective October 1, 2021

Medical policy updates and clinical guideline updates

New reimbursement policy: Non-patient Laboratory Services (Facility)

Reimbursement policy update: Consultations (Professional)

Federal Employee Program® AIM Radiology prior authorization review

Attention facilities: Sending admission, discharge and transfer data to Empire results in improved care management for patients

Let’s Vaccinate

New reimbursement policy: Modifier 90: Reference (Outside) Laboratory and Pass-Through Billing (Effective 10/01/21)

Prior authorization requirement changes effective September 1, 2021

Certain specialty medication precertification requests may require additional documentation

Medical drug benefit Clinical Criteria updates

Retraction: AIM Rehabilitative program — initial evaluations and site of service reviews

Updates to AIM Specialty Health Musculoskeletal program clinical appropriateness guidelines

Coding spotlight: mental disorders in childhood

What Matters Most: Improving the Patient Experience

Resources to support your diverse patient panel

Keep up with Medicaid news

Attention facilities: Sending admission, discharge and transfer data to Empire results in improved care management for patients

Let’s Vaccinate

New reimbursement policy: Modifier 90: Reference (Outside) Laboratory and Pass-Through Billing (Effective 10/01/21)

Prior authorization requirement changes effective October 1, 2021, for codes A0426 and A0428

Medical drug benefit Clinical Criteria updates

Voluntary recall of Philips Respironics CPAP machine, BiPAP machine, and ventilators

Let’s Vaccinate

Updates for specialty pharmacy effective September 1, 2021

Designated specialty pharmacy network updates

Pharmacy information available on empireblue.com

Regular check-ins with your clearinghouse could affect timely filing

Keep your contact information current

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

Two great learning resources on One Secure Portal

Submit EDI corrected claims via Availity or EDI

Digital Solution Options with Availity

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

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines

Updates to AIM Musculoskeletal Program Clinical Appropriateness Guidelines

Clinical Criteria updates for specialty pharmacy

Empire to enhance claim edits for Outpatient Facility Claims

DEXA bone scan criteria for the Federal Employee Program

Provider education program survey: Your Voice Counts

MCG Care Guidelines 25th Edition

Keeping up with routine vaccination during COVID-19

Aspire Health for members in need of palliative care

Complex Case Management program

Important information about utilization management

Members’ Rights and Responsibilities Statement

Keep up with Medicaid news

MCG Care Guidelines 25th Edition

Medical Policies and Clinical Utilization Management Guidelines update

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

Keep up with Medicare news

Register for upcoming CME webinars

Join us in a new CME webinar series as we share practices and success stories to overcoming barriers in achieving clinical quality goals, attaining better patient outcomes and improving Stars ratings.

5 Strategies to Improve Your Quality Measures - June 10^th, 12 p.m. or 3 p.m. ET
7 Ways to Enhance Your Patients’ Experience - June 17^th, 12 p.m. or 3 p.m. ET

Register now!

Register today for the In Pursuit of Racial Equity: Deconstructing Bias forum hosted by Empire and Motivo on June 9, 2021

Join us to hear from a diverse panel of experienced Motivo and Empire professionals about racial equity and implicit bias.

Modification to voluntary Cancer Care Quality Program (CCQP) enhanced reimbursement to begin July 1, 2021

Updates for Specialty pharmacy effective August 1, 2021

Specialty pharmacy prior authorization update - Certain drugs for treatment of ocular conditions continue to require prior authorization

Clinical criteria updates for specialty pharmacy

A helpful and complete guide to covered well-child visits

May is national high blood pressure education month

Provider bulletins for medical and itemized bill attachments

Send larger digital attachments through Availity

Resources to support diverse patients and communities

Appointment scheduler application

Referring to network DME providers for negative pressure wound therapy helps members save on out-of-pocket costs

2021 affirmative statement regarding Utilization Management decisions

Clinical guideline updates

Material adverse change (MAC) notification

Update to AIM Specialty Health oncologic imaging clinical appropriateness guidelines

Reimbursement policy update: Frequency editing (Professional)

Metabolic monitoring and diabetes screening measures for those on antipsychotics medications

Maximizing efficient, high quality COVID-19 screenings

Updates to the AIM Specialty Health musculoskeletal program clinical appropriateness guidelines

Continuing medical education/continuing education unit opportunities

Keep up with Medicaid news

Updates to the AIM Specialty Health musculoskeletal program clinical appropriateness guidelines

Maximizing efficient, high quality COVID-19 screenings

Keep up with Medicare news

Information from Empire for Care Providers about COVID-19 (Updated April 28, 2021)

We recently updated the effective date about reimbursement for the administration of the COVID-19 vaccine.

HEDIS 2021 Federal Employee Program® medical record request requirements

Keep up with Medicaid news

Notify us of telehealth services

In-office assessment program

Oncology dose reduction program beginning July 1, 2021

Medical drug benefit clinical criteria updates – November 2020

Medical drug benefit clinical criteria updates – December 2020