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Provider Spotlight

Jun 29, 2020

Information from Empire for Care Providers about COVID-19 (Updated June 29, 2020)

We recently updated FAQs to reflect the extension of coverage for telehealth and telephonic care.

Jun 25, 2020

Webinar recording now available for network providers on how to leverage telehealth to care for Behavioral Health patients during COVID-19 and beyond

Empire hosted a provider webinar to share information and resources with Behavioral Health providers to assist with maximizing the telehealth experience. Access the webinar recording to learn more about leveraging telehealth for behavioral health services.

Articles Recent

Title	Publication	Category	Date
Update: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and Setting determinations	July 2020 Empire Provider News	Products & Programs	Jul 1, 2020
Updated Coverage for HIV PrEP medications	July 2020 Empire Provider News	Pharmacy	Jul 1, 2020
Prior authorization updates for specialty pharmacy are available	July 2020 Empire Provider News	Pharmacy	Jul 1, 2020
Changes to Annual Verification Process	July 2020 Empire Provider News	Administrative	Jul 1, 2020
Suffolk County Lab Network	July 2020 Empire Provider News	Administrative	Jul 1, 2020
New MCG 24th Edition Guidelines	July 2020 Empire Provider News	Administrative	Jul 1, 2020
Claims Status Listing & Remittance Inquiry Updates for Atypical Providers	July 2020 Empire Provider News	Administrative	Jul 1, 2020
Welcome to the Custom Learning Center in Availity	July 2020 Empire Provider News	Administrative	Jul 1, 2020
CRA Reporting Update: 2020 Program Year Progression - What’s in it for you and your patients?	July 2020 Empire Provider News	Administrative	Jul 1, 2020
Medical Policy and Clinical Guideline updates	July 2020 Empire Provider News	Medical Policy & Clinical Guidelines	Jul 1, 2020
Clinical Criteria updates for specialty pharmacy are available	July 2020 Empire Provider News	Medical Policy & Clinical Guidelines	Jul 1, 2020
Admission review process for Empire Federal Employee Program® (FEP) members	July 2020 Empire Provider News	Federal Employee Plan (FEP)	Jul 1, 2020
Medical drug benefit Clinical Criteria updates	July 2020 Empire Provider News	Medicaid	Jul 1, 2020
Introducing Interactive Care Reviewer - An online prior authorization tool	July 2020 Empire Provider News	Medicaid	Jul 1, 2020
Coding spotlight: Provider guide to coding for cardiovascular conditions	July 2020 Empire Provider News	Medicaid	Jul 1, 2020
Keep up with Medicaid news	July 2020 Empire Provider News	Medicaid	Jul 1, 2020
Prior authorization codes moving from AIM Specialty Health to Empire	July 2020 Empire Provider News	Medicare	Jul 1, 2020
Medical drug benefit Clinical Criteria updates	July 2020 Empire Provider News	Medicare	Jul 1, 2020
In-Office Assessment Program	July 2020 Empire Provider News	Medicare	Jul 1, 2020
2020 Special Needs Plans	July 2020 Empire Provider News	Medicare	Jul 1, 2020
Introducing Interactive Care Reviewer - An online prior authorization tool	July 2020 Empire Provider News	Medicare	Jul 1, 2020
Keep up with Medicare news	July 2020 Empire Provider News	Medicare	Jul 1, 2020
Information from Empire for Care Providers about COVID-19 (Updated June 29, 2020) We recently updated FAQs to reflect the extension of coverage for telehealth and telephonic care.	COVID-19 Information	Administrative	Jun 29, 2020
Webinar recording now available for network providers on how to leverage telehealth to care for Behavioral Health patients during COVID-19 and beyond Empire hosted a provider webinar to share information and resources with Behavioral Health providers to assist with maximizing the telehealth experience. Access the webinar recording to learn more about leveraging telehealth for behavioral health services.	COVID-19 Information	Administrative	Jun 25, 2020
Webinar: How to Leverage Telehealth to Care for Behavioral Health Patients During COVID-19 and Beyond	N/A	Behavioral Health	Jun 1, 2020
Prior authorization updates for specialty pharmacy effective September 1, 2020	June 2020 Empire Provider News	Pharmacy	Jun 1, 2020
Clinical Criteria updates for specialty pharmacy are available	June 2020 Empire Provider News	Pharmacy	Jun 1, 2020
Pharmacy information available on empireblue.com	June 2020 Empire Provider News	Pharmacy	Jun 1, 2020
A special thank you to Care Providers Thank you for your tireless efforts in keeping our country healthy. For all you do, we would like to share a message of our gratitude.	COVID-19 Information	Administrative	Jun 1, 2020
Empire Enhances Process for Submitting Behavioral Health Authorizations - Now Available	June 2020 Empire Provider News	Behavioral Health	Jun 1, 2020
Follow-Up after Hospitalization for Mental Illness	June 2020 Empire Provider News	Behavioral Health	Jun 1, 2020
Be sure to notify Empire of changes to your demographic data	June 2020 Empire Provider News	Administrative	Jun 1, 2020
Empire to change ID numbers for City of New York members	June 2020 Empire Provider News	Administrative	Jun 1, 2020
Empire Covers HIV PrEP Medications at 100% for prevention	June 2020 Empire Provider News	Administrative	Jun 1, 2020
Empire CRA Program Update: Retrospective Program Begins; Prospective Program Continues	June 2020 Empire Provider News	Administrative	Jun 1, 2020
Availity Portal Notification Center	June 2020 Empire Provider News	Administrative	Jun 1, 2020
Quality Corner: CPT Category II Codes - Collaborating for enhanced patient care	June 2020 Empire Provider News	Administrative	Jun 1, 2020
Medical Policy Updates	June 2020 Empire Provider News	Medical Policy & Clinical Guidelines	Jun 1, 2020
Transition to AIM Rehabilitative Services Clinical Appropriateness Guidelines	June 2020 Empire Provider News	Medical Policy & Clinical Guidelines	Jun 1, 2020
New Reimbursement Policy: Nurse Practitioner and Physician Assistant Services - Professional	June 2020 Empire Provider News	Reimbursement Policies	Jun 1, 2020
Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline	June 2020 Empire Provider News	Medicaid	Jun 1, 2020
2020 affirmative statement concerning utilization management decisions	June 2020 Empire Provider News	Medicaid	Jun 1, 2020
Modifier use reminders	June 2020 Empire Provider News	Medicaid	Jun 1, 2020
Coding spotlight - provider’s guide to code social determinants of health	June 2020 Empire Provider News	Medicaid	Jun 1, 2020
Follow-Up After Hospitalization for Mental Illness	June 2020 Empire Provider News	Medicaid	Jun 1, 2020
Complex Case Management program	June 2020 Empire Provider News	Medicaid	Jun 1, 2020
Members’ Rights and Responsibilities Statement	June 2020 Empire Provider News	Medicaid	Jun 1, 2020
Important information about utilization management	June 2020 Empire Provider News	Medicaid	Jun 1, 2020
Keep up with Medicaid news	June 2020 Empire Provider News	Medicaid	Jun 1, 2020
Introducing Interactive Care Reviewer - an online prior authorization tool	June 2020 Empire Provider News	Medicare	Jun 1, 2020
Empire working with Optum to collect medical records for risk adjustment	June 2020 Empire Provider News	Medicare	Jun 1, 2020
Diabetes HbA1c < 8 HEDIS guidance	June 2020 Empire Provider News	Medicare	Jun 1, 2020
2020 Medicare risk adjustment provider trainings	June 2020 Empire Provider News	Medicare	Jun 1, 2020
Keep up with Medicare news	June 2020 Empire Provider News	Medicare	Jun 1, 2020
Empire Waives Cost Share for COVID-19 Treatment (Updated May 29, 2020) Effective April 1, we expanded coverage for our members undergoing treatment related to a COVID-19 diagnosis, which covers the waiver of cost shares for COVID-19 treatment received through December 31, 2020.	COVID-19 Information	Administrative	May 29, 2020
Mental Health Services for Fully Insured New York Members including Essential Workers Effective May 2, 2020, Empire is waiving cost sharing for in-network outpatient mental health services for all New York fully-insured members, including essential workers.	COVID-19 Information	Administrative	May 15, 2020
Prior authorization updates for specialty pharmacy are available	May 2020 Empire Provider News	Pharmacy	May 1, 2020
COVID-19 Information repository for Empire Care Providers	May 2020 Empire Provider News	Administrative	May 1, 2020
Empire Commercial Risk Adjustment (CRA) Prospective Program Update: Assessing Your Patients for Risk Adjustable Conditions	May 2020 Empire Provider News	Administrative	May 1, 2020
Quality Corner - Diabetes HbA1c<8 HEDIS Guidance	May 2020 Empire Provider News	Administrative	May 1, 2020
Medical Policy and Clinical Guideline updates	May 2020 Empire Provider News	Medical Policy & Clinical Guidelines	May 1, 2020
Clinical Criteria updates for specialty pharmacy are available	May 2020 Empire Provider News	Medical Policy & Clinical Guidelines	May 1, 2020
Updates to AIM Advanced Imaging Clinical Appropriateness Guideline	May 2020 Empire Provider News	Medical Policy & Clinical Guidelines	May 1, 2020
Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline	May 2020 Empire Provider News	Medical Policy & Clinical Guidelines	May 1, 2020
Updates to AIM MSK Interventional Pain Management Clinical Appropriateness Guideline	May 2020 Empire Provider News	Medical Policy & Clinical Guidelines	May 1, 2020
Updates to AIM Musculoskeletal Program Joint Surgery Clinical Appropriateness Guidelines	May 2020 Empire Provider News	Medical Policy & Clinical Guidelines	May 1, 2020
Reminder about System Updates	May 2020 Empire Provider News	Reimbursement Policies	May 1, 2020
Outpatient Surgical Grouper	May 2020 Empire Provider News	Reimbursement Policies	May 1, 2020
Correct Mailing Address for Federal Employee Program Paper Claims and Claims Related Correspondence	May 2020 Empire Provider News	Federal Employee Plan (FEP)	May 1, 2020
Reimbursement Policy Update: Unlisted, Unspecified or Miscellaneous Codes	May 2020 Empire Provider News	Medicaid	May 1, 2020
Acquisition of Beacon Health Options	May 2020 Empire Provider News	Medicaid	May 1, 2020
Reimbursement Policy Update: Unlisted, Unspecified or Miscellaneous Codes	May 2020 Empire Provider News	Medicare	May 1, 2020
Multi-dose packaging	May 2020 Empire Provider News	Medicare	May 1, 2020
Keep up with Medicare news	May 2020 Empire Provider News	Medicare	May 1, 2020
Webinar recording now available for network providers on SBA loans and other federal relief programs in response to COVID-19 (Updated May 1, 2020) Empire hosted a provider webinar to share information and resources with its network providers regarding opportunities providers have to access loans through the U.S Small Business Administration (SBA) and other federal programs in response to the economic impact of COVID-19. Access the webinar recording using the password “health” to learn more about federal financial relief for providers.	COVID-19 Information	Administrative	Apr 28, 2020
Federal Resources Available for Care Providers and Employers in the Federal CARES Act During the COVID-19 crisis, care providers are working to keep the country running while navigating the financial impact it is having on them. To help care providers navigate the resources available to them Empire has complied information on programs we have learned about that could provide additional financial relief during this crisis.	COVID-19 Information	Administrative	Apr 15, 2020
Patient Cost-Sharing for Laboratory Tests to Diagnose COVID-19, Provider Visits to Diagnose COVID-19, and all Telehealth Services	COVID-19 Information	Administrative	Apr 6, 2020
Empire to delay most 4/1/2020 formulary list updates for commercial health plan pharmacy benefit	COVID-19 Information	Pharmacy	Apr 1, 2020
Level of Care medical necessity reviews for upper and lower endoscopy procedures begin July 1, 2020	April 2020 Empire Provider News	Products & Programs	Apr 1, 2020
Empire prior authorization updates for specialty pharmacy are available	April 2020 Empire Provider News	Pharmacy	Apr 1, 2020
Pharmacy information available on empireblue.com	April 2020 Empire Provider News	Pharmacy	Apr 1, 2020
Information from Empire for Care Providers about COVID-19	April 2020 Empire Provider News	Administrative	Apr 1, 2020
Anthem, Inc., Empire’s parent company, acquires Beacon Health Options	April 2020 Empire Provider News	Administrative	Apr 1, 2020
Provider Transparency Update	April 2020 Empire Provider News	Administrative	Apr 1, 2020
Empire continues focus on updates to our public provider website	April 2020 Empire Provider News	Administrative	Apr 1, 2020
MCG Care Guidelines 24th Edition	April 2020 Empire Provider News	Administrative	Apr 1, 2020
Policy Updates	April 2020 Empire Provider News	Medical Policy & Clinical Guidelines	Apr 1, 2020
HEDIS 2020 Federal Employee Program® medical record request requirements	April 2020 Empire Provider News	Federal Employee Plan (FEP)	Apr 1, 2020
Prior authorization requirements: new 2020 codes for coverage and precertification	April 2020 Empire Provider News	Medicaid	Apr 1, 2020
Medical drug benefit Clinical Criteria updates (November 2019)	April 2020 Empire Provider News	Medicaid	Apr 1, 2020
Medical drug benefit Clinical Criteria updates (December 2019)	April 2020 Empire Provider News	Medicaid	Apr 1, 2020
Update to corrected claims filing guidelines	April 2020 Empire Provider News	Medicaid	Apr 1, 2020
Use of Imaging Studies for Low Back Pain (LBP)	April 2020 Empire Provider News	Medicaid	Apr 1, 2020
Disease Management can help you care for patients with chronic health care needs	April 2020 Empire Provider News	Medicaid	Apr 1, 2020
Appointment access standards for PCPs, specialty care and behavioral health practitioners	April 2020 Empire Provider News	Medicaid	Apr 1, 2020
Keep up with Medicaid news	April 2020 Empire Provider News	Medicaid	Apr 1, 2020
Medical drug benefit Clinical Criteria updates (November 2019)	April 2020 Empire Provider News	Medicare	Apr 1, 2020
Medical drug benefit Clinical Criteria updates (December 2019)	April 2020 Empire Provider News	Medicare	Apr 1, 2020
2020 Medicare risk adjustment provider trainings	April 2020 Empire Provider News	Medicare	Apr 1, 2020
Keep up with Medicare news	April 2020 Empire Provider News	Medicare	Apr 1, 2020

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