New York
Provider Communications

Correction: Physician Office Lab list updates effective October 1, 2022

Timely updates help keep our provider directories current

Introducing the Provider Learning Hub

Add supporting documents directly to your claims with the new Claims Status Send Attachments feature

Performance enhancements to the authorization application on Availity Essentials

Telehealth visits can impact after-hospitalization follow-up care for mental illness

Specialty pharmacy updates

Clinical Criteria updates for specialty pharmacy

Pharmacy information available online

Medical Policy and Clinical Guideline updates

HEDIS 2022: Summary of changes from NCQA

Chlamydia screening

Using SBIRT to address opioid and substance use disorders

The cost of alcohol use disorder

Prior authorization requirement changes updated effective date November 1, 2022

Prior authorizations for post-acute care

Empire expands specialty pharmacy precertification list

Join us for our next clinical quality in practice webinar

Reimbursement policy update: Laboratory and Venipuncture Services - Professional & Facility

Material Adverse Change (MAC)

Reimbursement policy update: Distinct Procedural Service, Modifiers 59 and XE, XP, XS, and XU - professional

Material Adverse Change (MAC)

New reimbursement policy: Transitional Care Management - professional

Retraction for reimbursement policy — Sexually Transmitted Infections - professional

New reimbursement policy: Place of Service - facility

Radiology prior authorization review transitioning to AIM

Prior authorization requirement changes effective August 1, 2022

MCG care guidelines 26th edition

Update to electronic verification visit key points

Provider reimbursement for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Counseling program

Keep up with Medicaid news- July 2022

View these Medicaid articles:

• Three-point match verification for professional claims payment
• Prior authorization updates for medications billed under the medical benefit
• Updates for medication codes billed under the medical benefit

MCG care guidelines 26th edition

Bedford Central School District, New York moves to the Empire BlueCross BlueShield Retiree Solutions Medicare Advantage Plan

Update use of Modifier 25 for billing for visits that include preventive services and problem-oriented evaluation and management services

Cancer Care Navigator

Keep up with Medicare news - July 2022

View this Medicare article:

• New specialty pharmacy medical step therapy requirements

Physician Office Lab Listing - updates effective August 1, 2022

Provider manual updated effective October 1, 2022

Introducing Elevance Health - Focusing on whole health and its most powerful drivers

Help patients heal from the comfort of home with Hospital in Home care

Updates to edits associated with implants

Enhanced reimbursement for voluntary Cancer Care Quality program to be discontinued effective December 31, 2022

Update to facility editing: HCPCS code G0463

CAA: Keep your provider directory information current

More potato chips, sugary drinks, and less physical activity are key contributors to childhood obesity

Clearing up coding confusion for diabetic retinal screenings

Coming soon: The Empire BlueCross BlueShield Provider Learning Hub makes Availity learning easier

Enhancing claims attachment processes through digital applications

MCG to InterQual Behavioral Health Transition

Clinical Criteria updates for specialty pharmacy

Material Adverse Change (MAC)

Pharmacy information available online

New reimbursement policy: Modifier FB – Professional and Facility

Reimbursement policy update: Modifier Rules – Professional

Introducing Elevance Health — Focusing on whole health and its most powerful drivers

Exploring the Intersection of Race and Disability

Provider outreach to validate your provider data

Evaluation and management services for COVID testing - professional

Material adverse change (MAC)

Exploring the Intersection of Race and Disability

Once-a-year testing is critically important to providing quality diabetes care

CAA: Provider directories accuracy is important

Opioid overdose deaths: What can we do?

Specialty pharmacy updates - June 2022

Updates to AIM Specialty Health advanced imaging clinical appropriateness guidelines

Material Adverse Change (MAC)

Updates to AIM Specialty Health musculoskeletal clinical appropriateness guidelines

Updates to AIM Specialty Health sleep disorder management clinical appropriateness

Material Adverse Change (MAC)

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

Material Adverse Change (MAC)

Process change for Federal Employee Program® third-party correspondence requests

Provider notice for COVID-19 testing

InterQual migration

Medical Policies and Clinical Utilization Management Guidelines update

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

Keep up with Medicaid news- June 2022

View these Medicaid articles:

• Prior authorization update for select durable medical equipment (DME) items
• Prior authorization updates for medications billed under the medical benefit
• Updates to AIM Specialty Health Musculoskeletal Clinical Appropriateness Guidelines
• Updates to AIM Specialty Health Sleep Disorder Management Clinical Appropriateness Guidelines
• Medical drug benefit Clinical Criteria updates

Provider notice for COVID-19 testing

Medical drug benefit Clinical Criteria updates

Medical Policies and Clinical Utilization Management Guidelines update

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

Keep up with Medicare news - June 2022

View these Medicare articles:

• New specialty pharmacy medical step therapy requirements
• Empire BlueCross BlueShield expands specialty pharmacy precertification list
• Updates to AIM Specialty Health Musculoskeletal Clinical Appropriateness Guidelines
• Updates to AIM Specialty Health Sleep Disorder Management Clinical Appropriateness Guidelines

Empire announces changes to post-payment audits conducted on our behalf

Action required: Conversion to a new reimbursement system for outpatient facility services

Coding tips for reporting administration of Spravato®

CAA: Timely updates help keep our provider directories current

Primary care appointment access and open panels

Resources to support diverse patients and communities

May is national high blood pressure education month: We’ve got this!

Alcohol use disorder has a big cost

Clinical Criteria updates for specialty pharmacy

Material Adverse Change (MAC)

Specialty pharmacy updates - May 2022

Medical policy and clinical guideline updates

Material Adverse Change (MAC)

Join us for an FEP Quality Learning program live webinar

CORRECTION: Save time tomorrow by using CPT II codes today: Introducing the FEP® Quality Reimbursement Program for PPO providers

Federal Employee Program® AIM radiology prior authorization review reminder

Screening for alcohol use disorder in high-prevalence demographics

New Strategic Provider System implementation May 2022

CPT Category II update

Keep up with Medicaid news- May 2022

View these Medicaid articles:

• Prior authorization requirement changes for HCPCS code K1022
• New specialty pharmacy medical step therapy requirements

Convenient, reliable at-home testing for colorectal cancer and diabetes care

HEDIS 2022: summary of changes from NCQA

New specialty pharmacy medical step therapy requirements

Keep up with Medicare news - May 2022

View these Medicare articles:

• Empire BlueCross BlueShield expands specialty pharmacy precertification list
• Empire BlueCross BlueShield expands specialty pharmacy precertification list
• New specialty pharmacy medical step therapy requirements

Information from Empire for Care Providers about COVID-19 (Updated April 20, 2022)

We recently updated information about codes for telehealth and telemedicine care.

Improving antibiotic use for acute respiratory infections in the outpatient setting

The Anthem, Inc. name is changing