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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)

Authorizations for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) services for consumers with individual, group retiree solutions (GRS), and dual-eligible plans from Medicare Advantage

E-visits

IBEW Local 25, New York moves to the Retiree Solutions Medicare Advantage Plan from Empire BlueCross BlueShield

Keep up with Medicare news - April 2023

• Clinical Criteria updates
• Clinical Criteria updates
• Empire BlueCross BlueShield expands specialty pharmacy precertification list (Imjudo, Pedmark, Tecvayli, Tzield, Vegzelma)
• Empire BlueCross expands specialty pharmacy precertification list (Elahere)
• New specialty pharmacy medical step therapy requirements (Beovu, Macugen)
• Genetic testing CPT code list update for Carelon Medical Benefits Management (formerly AIM Specialty Health)*
• Pay Doctor Bill (provider payment option) — General FAQ
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HEDIS 2023 Federal Employee Program medical record request requirements

FEP Quality Reimbursement Program update

Federal Employee Program change for medical dental reimbursement

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

Informational Update: Modifier Usage (Policy G-06006)

Shared savings and transition care management after inpatient discharges

Controlling High Blood Pressure and Submitting Compliant Readings

Keep up with Medicare news - March 2023

• Updates to Carelon Medical Benefits Management, Inc. Cardiac Clinical Appropriateness Guidelines
• Carelon Medical Benefits Management, Inc. Genetic Testing Clinical Appropriateness Guidelines CPT code list update
• Clinical Criteria updates
• New specialty pharmacy medical step therapy requirements (Neulasta, Neulasta OnPro, Udenyca)

Keep up with Medicaid news - February 2023

Mutual of America New York moves to the Empire BlueCross BlueShield retiree solutions Medicare Advantage plan

City of Manchester Offers Medicare Advantage Option

Keep up with Medicare news - February 2023

• Introducing the Provider Learning Hub
• Empire BlueCross expands specialty pharmacy precertification list (Fylnetra)
• Empire BlueCross expands specialty pharmacy precertification list (Spevigo, Xenpozyme)
• Specialty pharmacy precertification list expansion (Rolvedon, Stimufend)
• New specialty pharmacy medical step therapy requirements (Infed, Injectafer, Monoferric)
• AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update
• Prior authorization requirement changes effective April 1, 2023
• Medical Policies and Clinical Utilization Management Guidelines update
• Revised program implementation date prior authorizations for post-acute care
• Updates to AIM Specialty Health Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines
• Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines
• Name change announcement: myNEXUS will transition to Carelon Post Acute Solutions on March 1, 2023

Federal Employee Program observation conversion for musculoskeletal cases

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

Keep up with Medicare news - January 2023

• Prior authorization requirement changes
• New specialty pharmacy medical step therapy requirements
• Empire BlueCross BlueShield expands specialty pharmacy precertification list

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

Courtesy notification of specialty pharmacy medical step therapy updates

2023 Medicare Advantage service area and benefit updates

Personal home helper benefit ending

Keep up with Medicare news - December 2022

• Clinical Criteria updates
• Medical Policies and Clinical Utilization Management Guidelines update
• AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update
• Empire BlueCross BlueShield expands specialty pharmacy precertification list

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

Keep up with Medicare news - November 2022

• Medical drug benefit Clinical Criteria updates
• New specialty pharmacy medical step therapy requirements (Avastin, Mvasi)
• New specialty pharmacy medical step therapy requirements (Zarxio)

Availity Provider Chat - a fast, easy way to get your UM questions answered for Federal Employees

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

Webinars for New York Department of Health behavioral health carve-in for Medicaid Advantage Plus

Medicare telehealth services during the Coronavirus (COVID-19) public health emergency (PHE) FAQ

Courtesy notification of specialty pharmacy medical step therapy updates

Reimbursement Policy Retraction: Sexually Transmitted Infections Testing (Professional)

Keep up with Medicare news - October 2022

• Empire BlueCross BlueShield expands specialty pharmacy precertification list
• Empire BlueCross BlueShield expands specialty pharmacy precertification list 
• Consultation codes

OBRA 93 claim filing for Federal Employee Program

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

Prior authorization requirement changes effective December 1, 2022

Reimbursement policy update: Modifiers 25 and 57: Evaluation and Management with Global Procedures (Policy G- 06003)

Enhancing claims attachment processes through digital applications

Empire BlueCross BlueShield expands specialty pharmacy precertification list – effective 11/1/2022

Empire BlueCross BlueShield expands specialty pharmacy precertification list - effective 12/1/2022

Reminder: AIM prior authorization phone number change for Medicare

Keep up with Medicare news - September 2022

• Clinical Criteria Updates
• Medicare telehealth services during the Coronavirus (COVID-19) public health emergency (PHE) FAQ

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

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

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

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