New York
Provider Communications

Articles Category: State & Federal

Title Publication Category Date

Radiology prior authorization review transitioning to AIM

July 2022 Newsletter Federal Employee Plan (FEP) Jul 1, 2022

Prior authorization requirement changes effective August 1, 2022

July 2022 Newsletter Medicaid Jul 1, 2022

MCG care guidelines 26th edition

July 2022 Newsletter Medicaid Jul 1, 2022

Update to electronic verification visit key points

July 2022 Newsletter Medicaid Jul 1, 2022

Provider reimbursement for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Counseling program

July 2022 Newsletter Medicaid Jul 1, 2022

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
July 2022 Newsletter Medicaid Jul 1, 2022

MCG care guidelines 26th edition

July 2022 Newsletter Medicare Jul 1, 2022

Bedford Central School District, New York moves to the Empire BlueCross BlueShield Retiree Solutions Medicare Advantage Plan

July 2022 Newsletter Medicare Jul 1, 2022

Update use of Modifier 25 for billing for visits that include preventive services and problem-oriented evaluation and management services

July 2022 Newsletter Medicare Jul 1, 2022

Cancer Care Navigator

July 2022 Newsletter Medicare Jul 1, 2022

Keep up with Medicare news - July 2022

View this Medicare article:

  • New specialty pharmacy medical step therapy requirements
July 2022 Newsletter Medicare Jul 1, 2022

Process change for Federal Employee Program® third-party correspondence requests

June 2022 Newsletter Federal Employee Plan (FEP) Jun 1, 2022

Provider notice for COVID-19 testing

June 2022 Newsletter Medicaid Jun 1, 2022

InterQual migration

June 2022 Newsletter Medicaid Jun 1, 2022

Medical Policies and Clinical Utilization Management Guidelines update

June 2022 Newsletter Medicaid Jun 1, 2022

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

June 2022 Newsletter Medicaid Jun 1, 2022

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
June 2022 Newsletter Medicaid Jun 1, 2022

Provider notice for COVID-19 testing

June 2022 Newsletter Medicare Jun 1, 2022

Medical drug benefit Clinical Criteria updates

June 2022 Newsletter Medicare Jun 1, 2022

Medical Policies and Clinical Utilization Management Guidelines update

June 2022 Newsletter Medicare Jun 1, 2022

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

June 2022 Newsletter Medicare Jun 1, 2022

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
June 2022 Newsletter Medicare Jun 1, 2022

Join us for an FEP Quality Learning program live webinar

May 2022 Newsletter Federal Employee Plan (FEP) May 1, 2022

CORRECTION: Save time tomorrow by using CPT II codes today: Introducing the FEP® Quality Reimbursement Program for PPO providers

May 2022 Newsletter Federal Employee Plan (FEP) May 1, 2022

Federal Employee Program® AIM radiology prior authorization review reminder

May 2022 Newsletter Federal Employee Plan (FEP) May 1, 2022

Screening for alcohol use disorder in high-prevalence demographics

May 2022 Newsletter Medicaid May 1, 2022

New Strategic Provider System implementation May 2022

May 2022 Newsletter Medicaid May 1, 2022

CPT Category II update

May 2022 Newsletter Medicaid May 1, 2022

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
May 2022 Newsletter Medicaid May 1, 2022

Convenient, reliable at-home testing for colorectal cancer and diabetes care

May 2022 Newsletter Medicare May 1, 2022

HEDIS 2022: summary of changes from NCQA

May 2022 Newsletter Medicare May 1, 2022

New specialty pharmacy medical step therapy requirements

May 2022 Newsletter Medicare May 1, 2022

Keep up with Medicare news - May 2022

View these Medicare articles:

  • Empire BlueCross BlueShield expands specialty pharmacy precertification list
  • Empire BlueCross BlueShield expands specialty pharmacy precertification list
  • New specialty pharmacy medical step therapy requirements
May 2022 Newsletter Medicare May 1, 2022

Save time by using CPT II codes: Introducing FEP Quality Reimbursement Program for PPO providers

April 2022 Newsletter Federal Employee Plan (FEP) Apr 1, 2022

The Anthem, Inc. name is changing

April 2022 Newsletter Medicaid Apr 1, 2022

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

April 2022 Newsletter Medicaid Apr 1, 2022

Reimbursement Policy Update: Inpatient Readmissions

April 2022 Newsletter Medicaid Apr 1, 2022

Disease Management/Population Health program

April 2022 Newsletter Medicaid Apr 1, 2022

Clinical Criteria updates

April 2022 Newsletter Medicaid Apr 1, 2022

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
April 2022 Newsletter Medicaid Apr 1, 2022

The Anthem, Inc. name is changing

April 2022 Newsletter Medicare Apr 1, 2022

Implementation update for the NYC Medicare Advantage Plus plan, an alliance between Empire BlueCross BlueShield and EmblemHealth

April 2022 Newsletter Medicare Apr 1, 2022

Reimbursement Policy Update: Inpatient Readmissions

April 2022 Newsletter Medicare Apr 1, 2022

Clinical Criteria updates

April 2022 Newsletter Medicare Apr 1, 2022

Model of Care required training

April 2022 Newsletter Medicare Apr 1, 2022

The impact of listening

April 2022 Newsletter Medicare Apr 1, 2022

Keep up with Medicare news – April 2022

View these Medicare articles:

  • Medical Policies and Clinical Utilization Management Guidelines update
  • Empire BlueCross BlueShield expands specialty pharmacy precertification list
  • AIM Specialty Health Outpatient Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines updates
April 2022 Newsletter Medicare Apr 1, 2022

Change to the Federal Employee Program® Clinical Grievance and Appeal Address

March 2022 Newsletter Federal Employee Plan (FEP) Mar 1, 2022

HEDIS 2022 Federal Employee Program® medical record request requirements

March 2022 Newsletter Federal Employee Plan (FEP) Mar 1, 2022

Required: Cultural competence training

March 2022 Newsletter Medicaid Mar 1, 2022

It is CAHPS survey time!

March 2022 Newsletter Medicaid Mar 1, 2022

Urinary tract infection toolkits are on the way

March 2022 Newsletter Medicaid Mar 1, 2022

New Strategic Provider System will launch in April 2022

March 2022 Newsletter Medicaid Mar 1, 2022

New select plans on our HealthPlus Medicare network

March 2022 Newsletter Medicare Mar 1, 2022

Annual wellness visits for Medicare Advantage members

March 2022 Newsletter Medicare Mar 1, 2022

Medication adherence

March 2022 Newsletter Medicare Mar 1, 2022

Clinical Criteria updates

March 2022 Newsletter Medicare Mar 1, 2022

Provider notification for utilization management authorization rule operations workgroup item 2662

March 2022 Newsletter Medicare Mar 1, 2022

Keep up with Medicare news - March 2022

View these Medicare articles:

  • Medical step therapy updates
March 2022 Newsletter Medicare Mar 1, 2022

Get faster payments with EFT

February 2022 Newsletter Medicaid Feb 1, 2022

Get faster payments with EFT

February 2022 Newsletter Medicare Feb 1, 2022

2022 FEP® Benefit information available online

January 2022 Newsletter Federal Employee Plan (FEP) Jan 1, 2022

Botox update for Empire BlueCross BlueShield HealthPlus members

January 2022 Newsletter Medicaid Jan 1, 2022

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

January 2022 Newsletter Medicaid Jan 1, 2022

2021 CAHPS Survey results

January 2022 Newsletter Medicaid Jan 1, 2022

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
January 2022 Newsletter Medicaid Jan 1, 2022

NYC Medicare Advantage Plus effective date change

January 2022 Newsletter Medicare Jan 1, 2022

Important update on Botox® for Medicare members of Empire BlueCross BlueShield

January 2022 Newsletter Medicare Jan 1, 2022

Local 282 Welfare Trust Fund moves to Empire MediBlue Freedom (PPO) Medical plan

January 2022 Newsletter Medicare Jan 1, 2022

Professional claims — billing referring provider and NPI for home infusion therapy and ambulatory infusion suite

January 2022 Newsletter Medicare Jan 1, 2022

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

January 2022 Newsletter Medicare Jan 1, 2022

Keep up with Medicare news - January 2022

View these Medicare articles:

  • Medical step therapy updates
  • Empire BlueCross expands specialty pharmacy precertification list
  • AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines
    update
January 2022 Newsletter Medicare Jan 1, 2022

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

December 2021 Newsletter Medicaid Dec 1, 2021

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

December 2021 Newsletter Medicaid Dec 1, 2021

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

December 2021 Newsletter Medicaid Dec 1, 2021

Claims editing update for ICD-10-CM Excludes1 notes

December 2021 Newsletter Medicaid Dec 1, 2021

Updates to AIM Specialty Health Advanced Imaging clinical appropriateness guidelines

December 2021 Newsletter Medicaid Dec 1, 2021

Medical Policies and Clinical Utilization Management Guidelines update

December 2021 Newsletter Medicaid Dec 1, 2021

Good news: Non-payment remittance advice enhancements are here

December 2021 Newsletter Medicaid Dec 1, 2021

Submitting prior authorizations is getting easier

December 2021 Newsletter Medicaid Dec 1, 2021

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
December 2021 Newsletter Medicaid Dec 1, 2021

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

December 2021 Newsletter Medicare Dec 1, 2021

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

December 2021 Newsletter Medicare Dec 1, 2021

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

December 2021 Newsletter Medicare Dec 1, 2021

Updates to AIM Specialty Health Advanced Imaging clinical appropriateness guidelines

December 2021 Newsletter Medicare Dec 1, 2021

2022 Medicare Advantage service area and benefit updates

December 2021 Newsletter Medicare Dec 1, 2021

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

December 2021 Newsletter Medicare Dec 1, 2021

Good news: Non-payment remittance advice enhancements are here

December 2021 Newsletter Medicare Dec 1, 2021

Submitting prior authorizations is getting easier

December 2021 Newsletter Medicare Dec 1, 2021

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
December 2021 Newsletter Medicare Dec 1, 2021

New York state Medicaid expansion of coverage for colorectal cancer screening

November 2021 Newsletter Medicaid Nov 1, 2021

Electronic data interchange process

November 2021 Newsletter Medicaid Nov 1, 2021

Clinical Criteria updates

November 2021 Newsletter Medicaid Nov 1, 2021

Unspecified diagnosis reminder

November 2021 Newsletter Medicaid Nov 1, 2021

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

November 2021 Newsletter Medicaid Nov 1, 2021

Keep up with Medicaid news - November 2021

View these Medicaid articles:
  • Medicaid continuous glucose monitoring systems
  • Prior authorization updates for specialty pharmacy
November 2021 Newsletter Medicaid Nov 1, 2021

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

November 2021 Newsletter Medicare Nov 1, 2021

Electronic data interchange process

November 2021 Newsletter Medicare Nov 1, 2021

Clinical Criteria updates

November 2021 Newsletter Medicare Nov 1, 2021

Empire BlueCross BlueShield offering Advance Medical Directives program for 2022

November 2021 Newsletter Medicare Nov 1, 2021
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