New York
Provider Communications

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

Update to the Pregnancy Notification Form

Update to corrected claims filing guidelines

Oral health equity

Electronic data interchange gateway update

Empire HealthPlus adopts MCG Care Guidelines for clinical reviews of mental health services

Prior authorization requirements for Sublocade

Prior authorization requirements for Subcutaneous Implantable Defibrillator system

Verifying and updating your provider information

UPDATE: Prior authorization requirements for high-level, definitive drug testing delayed

Improving the patient experience

Viral suppression rates improve in patients with HIV in the US,while disparities continue to exist

Medical drug benefit Clinical Criteria updates - August 2019

Reimbursement Policy Update: Claims Requiring Additional Documentation (Policy 06-031, effective 03/01/19)

Medical drug benefit Clinical Criteria - September 2019

Transition of Outpatient Rehabilitation Utilization Management Program effective January 1, 2019

Medical Policies and Clinical Utilization Management Guidelines update

Medical Policies and Clinical Utilization Management Guidelines update

Coding spotlight - provider’s guide to coding respiratory diseases

Prior authorization requirement changes effective August 1, 2022

Electronic Data Interchange migration to Availity

Coding spotlight: substance use disorders and smoking

What Matters Most online training course: improving patient experience

MCG care guidelines 26th edition

New pregnancy notification process using the Availity Portal Benefit Look-Up tool

Pharmacy management information

Medical drug benefit Clinical Criteria updates

Provider notice for COVID-19 testing

Update to electronic verification visit key points

Normal newborn diagnosis-related group claims processing update

Practitioners’ rights during credentialing process

InterQual migration

Prior authorization requirements for Cabazitaxel (Jevtana)

Medical Policies and Clinical Utilization Management Guidelines update

Medical Policies and Clinical Utilization Management Guidelines update

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

Prior authorization requirements for injectable/infusible drugs: mepolizumab (Nucala) and reslizumab (Cinqair)

Keep up with Medicaid news

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

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

Coding Spotlight - Obesity

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

Reimbursement Policy Update: Medical Recalls

Controlling High Blood Pressure (CBP)

New HEDIS/QARR measures for 2018

Medical drug benefit Clinical Criteria updates

Provider data update

Home- and community-based services for Health and Recovery Plan beneficiaries

Transition to AIM Rehabilitative Services Clinical Appropriateness Guidelines

Keep up with Medicaid news

Important information about utilization management

Reimbursement Policy Update: Early and Periodic Screening, Diagnosis and Treatment (EPSDT) (Effective 05/01/20)

Keep up with Medicaid news

Member’s Rights and Responsibilities Statement

Resources to support your diverse patient panel

Non-covered codes for Medicaid Managed Care (MMC) providers

Keep up with Medicaid news

Empire to conduct post-payment reviews of distinct procedural services modifiers

Miscellaneous durable medical equipment billing guidelines

Prior authorization requirement update for Mylotarg (gemtuzumab ozogamicin)

Electrical stimulation device to require prior authorization

Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service

Provider education program survey: Your Voice Counts

Lower extremity vascular intervention codes require prior authorization

Prior authorization requirements for Darzalex (daratumumab) drug

MCG Care Guidelines 25th Edition

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

Services requiring prior authorization

Medical Policies and Clinical Utilization Management Guidelines update

Behavioral health network provider training

Keeping up with routine vaccination during COVID-19

Behavioral health Discharge Action Plan: improving care transitions

Provider surveys

Use the Provider Maintenance Form to update your information

Complex Case Management program

Aspire Health for members in need of palliative care

What Matters Most: Improving the Patient Experience

Complex Case Management program

Coding Spotlight: Pregnancy, A provider’s guide to diagnose and code for pregnancy

Important information about utilization management

Members’ Rights and Responsibilities Statement

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

The Anthem, Inc. name is changing

Certain specialty medication precertification requests may require additional documentation

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

Medical drug benefit Clinical Criteria updates

Reimbursement Policy Update: Inpatient Readmissions

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

Disease Management/Population Health program

Updates to AIM Specialty Health Musculoskeletal program clinical appropriateness guidelines

Clinical Criteria updates

Coding spotlight: mental disorders in childhood

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

What Matters Most: Improving the Patient Experience

Resources to support your diverse patient panel

Update: evaluation and management with Modifier 25