New York
Provider Communications

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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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)

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

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

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

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)

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

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

Prior authorizations for post-acute care

Empire expands specialty pharmacy precertification list

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

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

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

HEDIS 2022: summary of changes from NCQA

New specialty pharmacy medical step therapy requirements

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

The Anthem, Inc. name is changing

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

Reimbursement Policy Update: Inpatient Readmissions

Clinical Criteria updates

Model of Care required training

The impact of listening

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

New select plans on our HealthPlus Medicare network

Annual wellness visits for Medicare Advantage members

Medication adherence

Clinical Criteria updates

Provider notification for utilization management authorization rule operations workgroup item 2662

Keep up with Medicare news - March 2022

View these Medicare articles:

• Medical step therapy updates

Get faster payments with EFT

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

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

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

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

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

City of New York offers Medicare Advantage option in 2022

Preventing claims denials: Shingles vaccine

Policy reminder: Inpatient Readmissions

Keep up with Medicare 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