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Provider Spotlight

Nov 13, 2020

Information from Empire for Care Providers about COVID-19 (Updated November 13, 2020)

We recently updated FAQs about cost shares for COVID-19 testing.

Articles Recent

Title	Publication	Category	Date
Information from Empire for Care Providers about COVID-19 (Updated November 13, 2020) We recently updated FAQs about cost shares for COVID-19 testing.	COVID-19 Information	Administrative	Nov 13, 2020
Reminder: Specialty Pharmacy Program expands Level of Care Reviews to NYC Hospital PPO Members Material Adverse Change (MAC) notification	November 2020 Empire Provider News	Products & Programs	Nov 1, 2020
Prior authorization updates for specialty pharmacy are available Material Adverse Change (MAC) notification	November 2020 Empire Provider News	Pharmacy	Nov 1, 2020
IngenioRx Introduces New Pharmacy Network in 2021	November 2020 Empire Provider News	Pharmacy	Nov 1, 2020
Clinical Criteria updates for specialty pharmacy are available Material Adverse Change (MAC) notification	November 2020 Empire Provider News	Pharmacy	Nov 1, 2020
Digital transactions cut administrative tasks in half	November 2020 Empire Provider News	Administrative	Nov 1, 2020
Clinical Laboratory Improvement Amendments (CLIA) Number – Additional Information	November 2020 Empire Provider News	Administrative	Nov 1, 2020
Availity Attachment Tools for Empire and Affiliate Payers – Live Webinars	November 2020 Empire Provider News	Administrative	Nov 1, 2020
US Antibiotic Awareness Week	November 2020 Empire Provider News	Administrative	Nov 1, 2020
Get the full picture of your patient’s health through their smartphone	November 2020 Empire Provider News	Administrative	Nov 1, 2020
Clinical Guideline Updates Material Adverse Change (MAC) notification	November 2020 Empire Provider News	Medical Policy & Clinical Guidelines	Nov 1, 2020
Reminder: Post-service reviews using AIM	November 2020 Empire Provider News	Medical Policy & Clinical Guidelines	Nov 1, 2020
Documentation Standards for Episodes of Care (Professional) Material Adverse Change (MAC) notification	November 2020 Empire Provider News	Reimbursement Policies	Nov 1, 2020
Modifier Rules (Professional) Material Adverse Change (MAC) notification	November 2020 Empire Provider News	Reimbursement Policies	Nov 1, 2020
Bundled Services and Supplies (Professional) Material Adverse Change (MAC) notification	November 2020 Empire Provider News	Reimbursement Policies	Nov 1, 2020
Attention: Updated laboratory fee schedule	November 2020 Empire Provider News	Medicaid	Nov 1, 2020
Transition to AIM Rehabilitative Service Clinical Appropriateness Guidelines	November 2020 Empire Provider News	Medicaid	Nov 1, 2020
Digital transactions cut administrative tasks in half	November 2020 Empire Provider News	Medicaid	Nov 1, 2020
Update: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and setting determinations	November 2020 Empire Provider News	Medicaid	Nov 1, 2020
Aspire Health telehealth palliative care program for Medicaid members in need of telephonic palliative care	November 2020 Empire Provider News	Medicaid	Nov 1, 2020
Medical drug benefit Clinical Criteria updates	November 2020 Empire Provider News	Medicaid	Nov 1, 2020
Reimbursement Policy: Nurse Practitioner and Physician Assistant Services (Professional)	November 2020 Empire Provider News	Medicaid	Nov 1, 2020
Coding spotlight: tips and best practices for compliance	November 2020 Empire Provider News	Medicaid	Nov 1, 2020
Inhaled nitric oxide reviews for diagnosis-related group admissions	November 2020 Empire Provider News	Medicaid	Nov 1, 2020
Provider transparency update	November 2020 Empire Provider News	Medicaid	Nov 1, 2020
New specialty pharmacy medical step therapy requirements (Herceptin)	November 2020 Empire Provider News	Medicaid	Nov 1, 2020
New specialty pharmacy medical step therapy requirements (Avastin)	November 2020 Empire Provider News	Medicaid	Nov 1, 2020
Keep up with Medicaid news	November 2020 Empire Provider News	Medicaid	Nov 1, 2020
Transition to AIM Rehabilitative Service Clinical Appropriateness Guidelines	November 2020 Empire Provider News	Medicare	Nov 1, 2020
Provider Chat — A fast, easy way to get your questions answered	November 2020 Empire Provider News	Medicare	Nov 1, 2020
Medical drug benefit Clinical Criteria updates	November 2020 Empire Provider News	Medicare	Nov 1, 2020
AIM rehabilitation prior authorizations suspended for Group Retiree Solutions members until December 31, 2020	November 2020 Empire Provider News	Medicare	Nov 1, 2020
FDA approvals and expedited pathways used — new molecular entities	November 2020 Empire Provider News	Medicare	Nov 1, 2020
Preferred continuous glucose monitors	November 2020 Empire Provider News	Medicare	Nov 1, 2020
Keep up with Medicare news	November 2020 Empire Provider News	Medicare	Nov 1, 2020
Nominate someone today for the Empire Whole Health Heroes Awards	Empire Whole Health Heroes Awards	Administrative	Oct 20, 2020
Register today for a Racial Trauma Forum hosted by Empire and Motivo on October 28, 2020	Racial Trauma Forum Invitation	Behavioral Health	Oct 14, 2020
Site of Care medical necessity reviews for a wide range of surgical procedures beginning January 1, 2021 Material Adverse Change	October 2020 Empire Provider News	Products & Programs	Oct 1, 2020
REMINDER: Expansion of AIM Musculoskeletal Program Effective November 1, 2020	October 2020 Empire Provider News	Products & Programs	Oct 1, 2020
Empire updates formulary lists for commercial health plan pharmacy benefit	October 2020 Empire Provider News	Pharmacy	Oct 1, 2020
Designated Specialty Pharmacies in 2021 Material Adverse Change	October 2020 Empire Provider News	Pharmacy	Oct 1, 2020
National Drug Code requirement on outpatient claims Material Adverse Change	October 2020 Empire Provider News	Pharmacy	Oct 1, 2020
Prior authorization updates for specialty pharmacy are available	October 2020 Empire Provider News	Pharmacy	Oct 1, 2020
Updated Coverage for Breast Cancer prevention medications	October 2020 Empire Provider News	Pharmacy	Oct 1, 2020
FDA approvals and expedited pathways used - New Molecular Entities (NMEs)	October 2020 Empire Provider News	Pharmacy	Oct 1, 2020
Pharmacy information available on empireblue.com	October 2020 Empire Provider News	Pharmacy	Oct 1, 2020
Keep up with important news from Empire and receive notifications by email	October 2020 Empire Provider News	Administrative	Oct 1, 2020
New Digital Provider Enrollment tool added to Availity for New York	October 2020 Empire Provider News	Administrative	Oct 1, 2020
New Blue HPN® network included in plans available for employee open enrollment Fall 2020	October 2020 Empire Provider News	Administrative	Oct 1, 2020
Charges for Personal Protective Equipment by Participating Providers	October 2020 Empire Provider News	Administrative	Oct 1, 2020
Electronic member ID cards available on the Availity Portal	October 2020 Empire Provider News	Administrative	Oct 1, 2020
Empire Chat: A fast, easy way to have your questions answered	October 2020 Empire Provider News	Administrative	Oct 1, 2020
Interactive Care Reviewer adds outpatient medical authorization requests for Empire local, State and City plans	October 2020 Empire Provider News	Administrative	Oct 1, 2020
Request referrals for Empire Individual Network Plan through Interactive Care Reviewer	October 2020 Empire Provider News	Administrative	Oct 1, 2020
New Medical Claim Attachment Webinars: Register Today	October 2020 Empire Provider News	Administrative	Oct 1, 2020
National Accounts 2021 Pre-certification list	October 2020 Empire Provider News	Administrative	Oct 1, 2020
CRA Reporting Update: New guidance on telephone-only service CPT codes for Risk Adjustment Program	October 2020 Empire Provider News	Administrative	Oct 1, 2020
What Matters Most: Improving the Patient Experience	October 2020 Empire Provider News	Administrative	Oct 1, 2020
Medical Policy & Clinical Guideline updates Material Adverse Changes	October 2020 Empire Provider News	Medical Policy & Clinical Guidelines	Oct 1, 2020
Clinical Criteria updates for specialty pharmacy are available Material Adverse Change	October 2020 Empire Provider News	Medical Policy & Clinical Guidelines	Oct 1, 2020
Transition to AIM Rehabilitative Service Clinical Appropriateness Guidelines	October 2020 Empire Provider News	Medical Policy & Clinical Guidelines	Oct 1, 2020
Reimbursement Policy Update: Emergency Department: Leveling of Evaluation and Management Services (Facility) Material Adverse Change	October 2020 Empire Provider News	Reimbursement Policies	Oct 1, 2020
Reimbursement Policy Update: Laboratory and Venipuncture (Professional) Material Adverse Change	October 2020 Empire Provider News	Reimbursement Policies	Oct 1, 2020
Federal Employee Program® Expands Specialty Pharmacy Prior Authorization List Material Adverse Change	October 2020 Empire Provider News	Federal Employee Plan (FEP)	Oct 1, 2020
Update: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and setting determinations	October 2020 Empire Provider News	Medicaid	Oct 1, 2020
SOMOS to manage delegated functions effective October 1, 2020	October 2020 Empire Provider News	Medicaid	Oct 1, 2020
Prior authorization requirements for E0482	October 2020 Empire Provider News	Medicaid	Oct 1, 2020
Asthma controller medications	October 2020 Empire Provider News	Medicaid	Oct 1, 2020
Patient360 enhancement for medical providers	October 2020 Empire Provider News	Medicaid	Oct 1, 2020
Coding spotlight: providers guide to coding for behavioral health disorders	October 2020 Empire Provider News	Medicaid	Oct 1, 2020
Keep up with Medicaid news	October 2020 Empire Provider News	Medicaid	Oct 1, 2020
Prior authorization requirements for the below codes (December 1, 2020)	October 2020 Empire Provider News	Medicare	Oct 1, 2020
Prior authorization requirements for the below codes (January 1, 2021)	October 2020 Empire Provider News	Medicare	Oct 1, 2020
Patient360 enhancement for medical providers	October 2020 Empire Provider News	Medicare	Oct 1, 2020
Social determinants of health support expanding with GroundGame Health	October 2020 Empire Provider News	Medicare	Oct 1, 2020
Evaluation and management services correct coding	October 2020 Empire Provider News	Medicare	Oct 1, 2020
Provider transparency update	October 2020 Empire Provider News	Medicare	Oct 1, 2020
Medical drug benefit Clinical Criteria updates	October 2020 Empire Provider News	Medicare	Oct 1, 2020
Keep up with Medicare news	October 2020 Empire Provider News	Medicare	Oct 1, 2020
Updates for specialty pharmacy are available	September 2020 Empire Provider News	Pharmacy	Sep 1, 2020
Empire to update formulary lists for commercial health plan pharmacy benefit	September 2020 Empire Provider News	Pharmacy	Sep 1, 2020
New provider directory indicators for medication assisted treatment (MAT) providers	September 2020 Empire Provider News	Administrative	Sep 1, 2020
EDI gateway migration deadline is September 15, 2020	September 2020 Empire Provider News	Administrative	Sep 1, 2020
Patient360 adds care gap alert feedback for medical providers	September 2020 Empire Provider News	Administrative	Sep 1, 2020
Enhanced medical records submission process to support claims processing	September 2020 Empire Provider News	Administrative	Sep 1, 2020
Providers can now receive and respond to medical record requests for postpay audit via Change Healthcare’s Assurance Attach Assist module	September 2020 Empire Provider News	Administrative	Sep 1, 2020
CRA reporting update: 2020 prospective program continues	September 2020 Empire Provider News	Administrative	Sep 1, 2020
Predictive Analytics guide proactive support to patients undergoing chemo, resulting in lowered admissions	September 2020 Empire Provider News	Administrative	Sep 1, 2020
Distinct Procedural Services- Modifiers 59, XE, XP, XS, XU (Professional)	September 2020 Empire Provider News	Reimbursement Policies	Sep 1, 2020
Frequency Editing (Professional)	September 2020 Empire Provider News	Reimbursement Policies	Sep 1, 2020
What Matters Most online training course: improving patient experience	September 2020 Empire Provider News	Medicaid	Sep 1, 2020
Medical drug benefit Clinical Criteria updates	September 2020 Empire Provider News	Medicaid	Sep 1, 2020
Medical Policies and Clinical Utilization Management Guidelines update	September 2020 Empire Provider News	Medicaid	Sep 1, 2020
Keep up with Medicaid news	September 2020 Empire Provider News	Medicaid	Sep 1, 2020
Update: Notice of changes to the AIM musculoskeletal program	September 2020 Empire Provider News	Medicare	Sep 1, 2020
Medical drug benefit Clinical Criteria updates	September 2020 Empire Provider News	Medicare	Sep 1, 2020
Keep up with Medicare news	September 2020 Empire Provider News	Medicare	Sep 1, 2020
New York Department of Financial Services Circular Letter on PPE The New York Department of Financial Services (“DFS”) recently issued a circular letter, “Charges for Personal Protective Equipment by Participating Providers”. In support with the letter, Empire is sharing with participating providers their responsibilities and working with providers to report the findings to DFS.	COVID-19 Information	Administrative	Aug 25, 2020
Mental Health Services for Fully Insured New York Members including Essential Workers Effective May 2, 2020, Empire began waiving cost sharing for in-network outpatient mental health services for all New York fully-insured members, including essential workers. This waiver will be in effect until September 28, 2020, unless further extended.	COVID-19 Information	Administrative	Aug 13, 2020
Expansion of AIM Musculoskeletal Program effective November 1, 2020	August 2020 Empire Provider News	Products & Programs	Aug 1, 2020

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