Material Adverse Change (MAC)

Effective May 1, 2023, Empire BlueCross BlueShield (Empire) is implementing a new policy related to submission of certain clinical data that builds upon our 2021 policy regarding sharing of ADT notifications.


When requested by Empire, providers will be required to submit clinical data (such as discharge summaries, consult notes, and medication lists) and admission, discharge, and transfer (ADT) data to Empire for certain healthcare operations functions. We collect this data to improve the quality and efficiency of healthcare delivery to our members. Providers are required to submit:

  • ADT data to Empire on a near real-time basis (no later than 24 hours) from the time of admission, discharge, or transfer of a member.
  • Clinical data for a member on a daily, weekly, or monthly basis, based on the provider's electronic medical record (EMR) or other electronic data sharing capabilities.


Empire’s permitted uses of the data with respect to clinical data requests include utilization management, case management, identification of gaps in care, conducting clinical quality improvement, risk adjustment, documentation in support of HEDIS® and other regulatory and accrediting reporting requirements, and for any other purpose permitted under HIPAA.


Empire has determined the data requested is the minimum necessary for Empire to accomplish its intended purposes. The data will be provided in accordance with data layout and format requirements defined by Empire. 


We value you as our partner in providing quality care and appreciate your continued participation in our network.


HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).


Featured In:
February 2023 Newsletter