New York
Provider Communications

2022 FEP® Benefit information available online

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

NYC Medicare Advantage Plus effective date change

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

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

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

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

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

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

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

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

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

Updates to AIM Specialty Health Advanced Imaging clinical appropriateness guidelines

2022 Medicare Advantage service area and benefit updates

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

Good news: Non-payment remittance advice enhancements are here

Submitting prior authorizations is getting easier

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

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

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

Electronic data interchange process

Clinical Criteria updates

Empire BlueCross BlueShield offering Advance Medical Directives program for 2022

Keep up with Medicare news - November 2021

View this Medicare article:

• Empire BlueCross BlueShield expands specialty pharmacy precertification list

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

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

Get your payments faster when you sign up for electronic funds transfer

Information about 2021 Special Needs Plans

HEDIS® medical record submission made easier with our Remote EMR Access Service

New Reimbursement Policy: Sexually Transmitted Infections Testing (Professional)

New Medical Step Therapy Requirements

Keep up with Medicare news - October 2021

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

Federal Employee Program® AIM Radiology prior authorization review transition delayed until November

Material adverse change (MAC) notification

Keep up with Medicaid news - September 2021

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

City of New York Offers NYC Medicare Advantage Plus Medicare Advantage Option

Reimbursement Policy Update: DRG Inpatient Facility Transfers (Effective 11/30/21)

Utilization management authorization rule operations

Prior authorization/Precertification form notification

Keep up with Medicare news - September 2021

• Clinical Criteria Updates Notification May 2021

Change in email submission of service requests for Federal Employee Program members

Keep up with Medicaid news

City of New York offers Medicare Advantage option in 2022

Preventing claims denials: Shingles vaccine

Policy reminder: Inpatient Readmissions

Keep up with Medicare news

Federal Employee Program® AIM Radiology prior authorization review

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

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 October 1, 2021, for codes A0426 and A0428

Medical drug benefit Clinical Criteria updates

DEXA bone scan criteria for the Federal Employee Program

Provider education program survey: Your Voice Counts

MCG Care Guidelines 25th Edition

Keeping up with routine vaccination during COVID-19

Aspire Health for members in need of palliative care

Complex Case Management program

Important information about utilization management

Members’ Rights and Responsibilities Statement

Keep up with Medicaid news

MCG Care Guidelines 25th Edition

Medical Policies and Clinical Utilization Management Guidelines update

Reminders for Medicare Advantage Group Retiree PPO plans and National Access Plus FAQ

Keep up with Medicare news

Metabolic monitoring and diabetes screening measures for those on antipsychotics medications

Maximizing efficient, high quality COVID-19 screenings