New York
Provider Communications

Provider Pathways - Doing business with Empire BlueCross BlueShield HealthPlus (Empire) eLearning is here!

Correct coding for hospital outpatient clinic visits for Medicaid

Ready, set, renew!

Keep up with Medicaid news - April 2023

• Clinical Criteria updates
• New specialty pharmacy medical step therapy requirements (Repatha, Leqvio, Praluent)

Policy Update: Modifiers 25 and 57 (Policy G-06003, effective 04/01/2023)

Keep up with Medicaid news - March 2023

• Clinical Criteria updates
• Prior authorization updates for medications billed under the medical benefit (Carvykti)
• Updates to Carelon Medical Benefits Management, Inc. Cardiac Clinical Appropriateness Guidelines

Keep up with Medicaid news - February 2023

Use of modifier 25 when billing for visits that include preventive services and problem-oriented evaluation and management services

Keep up with Medicaid news - January 2023

• This is Quitting: Helping teens and young adults quit vaping
• Update to AIM Specialty Health Genetic Testing Clinical Appropriateness Guidelines CPT code list
• AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update

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

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

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

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

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 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

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

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

The Anthem, Inc. name is changing

Syphilis, including congenital cases, on the rise in New York

Reimbursement Policy Update: Inpatient Readmissions

Disease Management/Population Health program

Clinical Criteria updates

Keep up with Medicaid news – April 2022

View these Medicaid articles:

• AIM Specialty Health Outpatient Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines updates
• Prior authorization updates for medications billed under the medical benefit
• Medical drug benefit Clinical Criteria updates
• Medical Policies and Clinical Utilization Management Guidelines update

Required: Cultural competence training

It is CAHPS survey time!

Urinary tract infection toolkits are on the way

New Strategic Provider System will launch in April 2022

Get faster payments with EFT

Botox update for Empire BlueCross BlueShield HealthPlus members

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

2021 CAHPS Survey results

Keep up with Medicaid news - January 2022

View these Medicaid articles:

• AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines
  update
• Prior authorization updates for medications billed under the medical
  benefit

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

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

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

Keep up with Medicaid news - October 2021

• 2021 affirmative statement concerning utilization management decisions
• May 2021 Medical Policies and Utilization Management Guidelines update

Keep up with Medicaid news - September 2021

• Clinical Criteria Updates Notification May 2021
• Iron Infusion Step Therapy
• Iron Infusion Prior Authorization Update

Keep up with Medicaid news

Attention facilities: Sending admission, discharge and transfer data to Empire results in improved care management for patients

Let’s Vaccinate

New reimbursement policy: Modifier 90: Reference (Outside) Laboratory and Pass-Through Billing (Effective 10/01/21)

Prior authorization requirement changes effective September 1, 2021

Certain specialty medication precertification requests may require additional documentation

Medical drug benefit Clinical Criteria updates

Retraction: AIM Rehabilitative program — initial evaluations and site of service reviews

Updates to AIM Specialty Health Musculoskeletal program clinical appropriateness guidelines

Coding spotlight: mental disorders in childhood

What Matters Most: Improving the Patient Experience

Resources to support your diverse patient panel

Keep up with Medicaid news