New York
Provider Communications

Prepare for the Consolidated Appropriations Act: Keep your provider directory information up to date

Facility option to receive verbal UM Notifications electronically

Submitting prior authorizations is getting easier

Empire is transitioning to the Availity Authorization app

Is prior authorization required?

Answering your questions about the new Availity Authorization app

Chlamydia screening for teens and young adults

Outpatient system updates for 2022

Professional system updates for 2022

Clinical practice and preventive health guidelines available on empireblue.com

Coordination of care

Member rights and responsibilities

Important information about utilization management

Case management program

Importance of PCP after-hours messaging

Behavioral healthcare appointment access requirements

Reminder: The 32BJ Health Fund Centers of Excellence for Bariatric and Joint Replacement Surgery program begins January 1, 2022

Reminder: EnrollSafe is available - electronic funds transfer enrollment portal for Empire providers

Utilization management tool available on Availity Payer Spaces: Authorization Rules Lookup tool

Empire to retire Blue Precision program on December 31, 2021

Clinical Criteria updates for specialty pharmacy

Specialty pharmacy updates - December 2021

Pharmacy information available on empireblue.com

Updates to AIM Specialty Health Musculoskeletal Interventional Pain Management clinical appropriateness guideline

Updates to AIM Specialty Health Cardiology clinical appropriateness guidelines

Updates to AIM Specialty Health Radiation Oncology clinical appropriateness guideline

Updates to AIM Advanced Imaging clinical appropriateness guideline

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

Material Adverse Change (MAC)

New reimbursement policy update: Modifier 62: Co-Surgeon Services and Modifier 66: Surgical Teams - professional

Material Adverse Change (MAC)

Reimbursement policy update: Virtual Visits - professional and facility

Reimbursement policy update: Drug Screen Testing (effective March 1, 2022)

Reimbursement policy update: Multiple and Bilateral Surgery - Professional and Facility (effective 03/01/22)

HEDIS measures: Follow-Up After ED Visits for Mental Illness and Alcohol and Drug Dependency

Claims editing update for ICD-10-CM Excludes1 notes

Updates to AIM Specialty Health Advanced Imaging clinical appropriateness guidelines

Medical Policies and Clinical Utilization Management Guidelines update

Good news: Non-payment remittance advice enhancements are here

Submitting prior authorizations is getting easier

Keep up with Medicaid news - December 2021

View these Medicaid articles:

• Durable medical equipment prior authorization requirement changes effective December 1, 2021
• Cancer Care Navigator
• Medical drug benefit Clinical Criteria updates
• Prior authorization updates for medications billed under the medical
  benefit
• Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines
• Updates to AIM Specialty Health musculoskeletal interventional pain management
  clinical appropriateness guideline

City of New York GRS Alliance Program (Updated 12/3/21)

Webinars for City of New York retirees transitioning to new Medicare Advantage plan (Updated 12/3/21)

Reimbursement Policy Update: Drug Screen Testing (effective March 1, 2022)

Updates to AIM Specialty Health Advanced Imaging clinical appropriateness guidelines

2022 Medicare Advantage service area and benefit updates

Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies

Good news: Non-payment remittance advice enhancements are here

Submitting prior authorizations is getting easier

Keep up with Medicare news - December 2021

View these Medicare articles:

• Medical drug benefit Clinical Criteria updates
• FAQ: NYC Medicare Advantage Plus
• Protocol for providers serving members with hearing aid
  coverage administered by Hearing Care Solutions
• Medical Policies and Clinical Utilization Management Guidelines update
• Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines
• Updates to AIM Specialty Health musculoskeletal interventional pain management
  clinical appropriateness guideline

Register today for a forum on Grief and Loss: The disproportionate impact of the pandemic on communities of color

Join us to hear from a diverse panel of experienced Motivo and Empire professionals about the disproportionate impact of the pandemic on communities of color.

City of New York Retirees transition to NYC Medicare Advantage Plus (Updated 12/3/21)

Blue High Performance Network name changing for 2022

Effective January 1, 2022: The 32BJ Health Fund Centers of Excellence for Bariatric and Joint Replacement surgery

Include referring provider name and NPI on home infusion therapy and ambulatory infusion suite professional claims

Time to prepare for HEDIS® medical record review

CME credits available in 2021 for a variety of clinical quality webinars - register now!

Reducing the burden of medical record review and improving health outcomes with ECDS reporting

Join Empire in talking about racism and its impact on health and earn continuing education credits

Be antibiotics aware: Protect your patient

Surprisingly easy ways to help patients quit smoking cigarettes

Change in coverage for continuous glucose monitors for some fully insured groups

EnrollSafe is available: Our new electronic funds transfer enrollment portal

Against medical advice (AMA) discharge physician tracking tool

Update regarding annual wellness visits for ACA-compliant health plans

Important update on Botox® for Empire members

Specialty pharmacy updates are available - November 2021

Material Adverse Change (MAC) notification

Clarification to reimbursement policy updates: Modifier Rules and Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation (Professional)

New York state Medicaid expansion of coverage for colorectal cancer screening

Electronic data interchange process

Clinical Criteria updates

Unspecified diagnosis reminder

4 things you can do to encourage cancer screenings for your women patients

Keep up with Medicaid news - November 2021

• Medicaid continuous glucose monitoring systems
• Prior authorization updates for specialty pharmacy

Webinars for City of New York retirees transitioning to new Medicare Advantage plan

Electronic data interchange process

Clinical Criteria updates

Empire BlueCross BlueShield offering Advance Medical Directives program for 2022

Keep up with Medicare news - November 2021

View this Medicare article:

• Empire BlueCross BlueShield expands specialty pharmacy precertification list

Join The Fenway Institute for a CME webinar about improving your LGBTQIA+ patient interactions

Join a live webinar, “LGBTQIA+ Care: Delivering Trust and Belonging with Every Interaction,” presented by the National LGBTQIA+ Health Education Center at The Fenway Institute. 

Join the American Heart Association for a CME webinar on hypertension and diabetes disease management

Chronic disease management strategies for your patients with hypertension and diabetes

Date: Friday, October 8, 2021

Time: 12:00 p.m. ET

Familiarize yourself with Empire’s Simplified Networks

Meet Dr. Carolyn Langer, Empire’s new Chief Medical Officer

Federal Price Transparency and Consolidated Appropriations Act phase in new mandates beginning January 1, 2022

Clarification: Empire’s enhanced claim edits for outpatient facility claims

Your recommendation is key to encouraging cancer screenings for your female patients

Are you talking to ALL of your patients about breast cancer screenings?

Looking to earn continuing medical education credits? Register for these on-demand webinars

Clinical appeals

Provider claim payment disputes for Empire’s Commercial lines of business

Good news! Non-payment remittance advice enhancements coming soon

REMINDER: EnrollSafe, the new electronic funds transfer enrollment portal for Empire providers – replacing CAQH Enrollhub effective November 1, 2021

Procedure searches in Find Care

Clinical Criteria updates for specialty pharmacy

Designated specialty pharmacy network updates effective January 1, 2022

Material adverse change (MAC) notification

Specialty pharmacy updates - October 2021

Pharmacy information available on empireblue.com

Medical policy and clinical guideline updates

Material adverse change (MAC) notification

Get your payments faster when you sign up for electronic funds transfer

Diabetes testing and screening HEDIS measures

New Reimbursement Policy: Sexually Transmitted Infections Testing (Professional)

FAQ: Update to AIM phone number

Prior authorization updates for specialty pharmacy IV

Prior authorization updates for specialty pharmacy V