New York
Provider Communications

Attention lab providers: COVID-19 update regarding reimbursement

Important information about utilization management

State of Connecticut employer group - BlueCare Prime update

IngenioRx will become CarelonRx on January 1, 2023

CAA: Timely updates help keep our provider directories current

Member assessment of PCP after-hours messaging in 2022

Clinical practice and preventive health guidelines available on empireblue.com

Signature requirements for laboratory orders or requisitions

Case management program

Coordination of care

Member’s assessment of behavioral healthcare after-hours messaging in 2022

Members’ rights and responsibilities

Clinical Criteria updates for specialty pharmacy

Pharmacy information available on the provider website

Specialty pharmacy updates - December 2022

AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update

AIM Specialty Health Genetic Testing Clinical Appropriateness Guidelines CPT Code List update

Reimbursement policy update: Bundled Services and Supplies - Professional

Reimbursement policy update: Treatment Rooms with Office Evaluation and Management Services - Facility

Update to the Pregnancy Notification Form

Oral health equity

Keep up with Medicaid news - December 2022

• Clinical Criteria updates
• Prior authorization requirement changes effective January 1, 2023
• Prior authorization updates for medications billed under the medical benefit
• Medical Policies and Clinical Utilization Management Guidelines update
• AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update

Courtesy notification of specialty pharmacy medical step therapy updates

2023 Medicare Advantage service area and benefit updates

Personal home helper benefit ending

Keep up with Medicare news - December 2022

• Clinical Criteria updates
• Medical Policies and Clinical Utilization Management Guidelines update
• AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update
• Empire BlueCross BlueShield expands specialty pharmacy precertification list

Physician Office Lab (POL) Listing - Updates Effective February 1, 2023

Support documentation for AIM prior authorization requests

Mail is being forwarded to new post office box addresses for one year

CAA: Keep your provider directory information up to date

Specialty pharmacy updates - November 2022

Claims status message enhancements: Providing clear descriptions and actionable next steps

Authorization application enhancements: Faster, easier, and more efficient

Submit digital attachments within 7 calendar days for claims filed with a PWK segment indicator

Now, you can submit one electronic claim dispute for multiple claims and access correspondence digitally, too

Visit the Provider Learning Hub to view our latest learning opportunities

Remote EMR access service for HEDIS

Medical Policy and Clinical Guideline updates

Transition to AIM Specialty Health Perirectal Hydrogel Spacer for Prostate Radiotherapy Clinical Appropriateness Guideline

Correction to reimbursement policy: Place of Service (Facility)

Guidance for coding evaluation and management services for new and established patients

Important information about utilization management

Antipsychotic medications and diabetes

Alcohol use disorders often coexist with psychiatric disorders

Webinars for New York Department of Health behavioral health carve-in for Medicaid Advantage Plus

Keep up with Medicaid news - November 2022

• Medical drug benefit Clinical Criteria updates
• Prior authorization requirement changes effective November 1, 2022

Webinars for New York Department of Health behavioral health carve-in for Medicaid Advantage Plus

Keep up with Medicare news - November 2022

• Medical drug benefit Clinical Criteria updates
• New specialty pharmacy medical step therapy requirements (Avastin, Mvasi)
• New specialty pharmacy medical step therapy requirements (Zarxio)

Register for our upcoming CME webinar about low back pain management

Physician Office Lab (POL) List - October updates postponed

Monkeypox and smallpox vaccines: Product code on claims

Precertification list change

National Accounts 2023 Pre-certification list

CAA: Review your online provider directory information

The Provider Learning Hub is here

IngenioRx will become CarelonRx on January 1, 2023

Specialty pharmacy updates - October 2022

Clinical Criteria updates for specialty pharmacy

Pharmacy information available on empireblue.com

Reimbursement policy update: Three-Dimensional (3D) Radiology Services - Professional and Facility

Reimbursement policy update: Multiple and Bilateral Surgery Processing - Professional

Availity Provider Chat - a fast, easy way to get your UM questions answered for Federal Employees

Webinars for New York Department of Health behavioral health carve-in for Medicaid Advantage Plus

Monkeypox resources and recommendations for our care providers

Members’ Rights and Responsibilities

Complex Case Management program

Flu vaccination reimbursement

Reimbursement Policy Retraction: Sexually Transmitted Infections Testing (Professional)

Keep up with Medicaid news - October 2022

• Prior authorization updates for medications billed under the medical benefit – effective 11/1/22
• Prior authorization updates for medications billed under the medical benefit – effective 12/1/22
• New specialty pharmacy medical step therapy requirements

Webinars for New York Department of Health behavioral health carve-in for Medicaid Advantage Plus

Medicare telehealth services during the Coronavirus (COVID-19) public health emergency (PHE) FAQ

Courtesy notification of specialty pharmacy medical step therapy updates

Reimbursement Policy Retraction: Sexually Transmitted Infections Testing (Professional)

Keep up with Medicare news - October 2022

• Empire BlueCross BlueShield expands specialty pharmacy precertification list
• Empire BlueCross BlueShield expands specialty pharmacy precertification list 
• Consultation codes

Continuing to explore the intersection of race and disability

Continuing to explore the intersection of race and disability

Monkeypox resources and recommendations for our care providers

New patient evaluation and management services when reported for the same patient within the last three years

Drug code billing reminder

Important information about women’s preventive care visits

Empire to accept Hospital in Home services

CAA: Current provider directory information is key for members and providers to engage with you seamlessly

Updates to the Claim Attachment workflow

New Back Pain Management Program

Specialty pharmacy updates - September 2022

Clinical Criteria updates for specialty pharmacy

Update to formulary lists for Commercial health plan pharmacy benefit

Reimbursement policy update - Modifier Rules (Professional)

Reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) (Professional)

Reimbursement policy update - Modifier 66: Surgical Teams (Professional)

OBRA 93 claim filing for Federal Employee Program

Reimbursement policy update: Modifiers 25 and 57: Evaluation and Management with Global Procedures (Policy G- 06003), (Informational only)

Clinical Criteria updates

New specialty pharmacy medical step therapy requirements

Enhancing claims attachment processes through digital applications

Alcohol use disorders linked to chronic diseases

Prior authorization requirement changes effective December 1, 2022

Reimbursement policy update: Modifiers 25 and 57: Evaluation and Management with Global Procedures (Policy G- 06003)

Enhancing claims attachment processes through digital applications

Empire BlueCross BlueShield expands specialty pharmacy precertification list – effective 11/1/2022