New York
Provider Communications

When and how to initiate Medicare Advantage reopenings

Medicare Advantage: New service types added to Availity

Individual Medicare plans move compound drugs off formulary beginning January 1, 2019

Medicare Advantage: New Reimbursement Policy: Drug Screen Testing (Policy 19-001, effective 10/01/19)

Medicare Part B drugs may include Step Therapy beginning January 1, 2019

Medicare Advantage: Special needs plans - provider training required

MediBlue Select HMO Network expands effective January 1, 2019

Keep up with Medicare news

Medical Policies updated

Keep up with Medicare news

MA members receive incentives for completing screenings

DME providers and physicians: important wheelchair prior authorization information

Submit PA medication requests electronically; new phone number for MA prescription PAs effective Sept. 1

CMS issues regulatory changes for short- and long-acting narcotics; days’ supply limits effective Jan. 1, 2019

MyDiversePatients.com addresses health care disparities

Keep up with Medicare news

Verifying and updating your provider information

Reminder: Medicare claims for secondary payer must be submitted after the 30-day Medicare remittance period

Medicare preferred continuous glucose monitors

Help protect your patients by providing medical ID protection - best practices

Reminder to Medicare Advantage providers

Healthcare Quality Patient Assessment Form and Patient Assessment Form

Update: Notice of changes to the AIM musculoskeletal program

Medical drug benefit Clinical Criteria updates

Medical drug benefit Clinical Criteria updates

Provider notice for COVID-19 testing

MCG care guidelines 26th edition

Electric Boat offers Medicare Advantage options

Keep up with Medicare news

Medical drug benefit Clinical Criteria updates

Keep up with Medicare News

Medical Policies and Clinical Utilization Management Guidelines update

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

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

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

Cologuard covered for Medicare Advantage

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

Peer-to-peer process can help clarify clinical record

Cancer Care Navigator

Motion Picture Industry Pension and Health Plans Offers Medicare Advantage Option

Keep up with Medicare news - July 2022

View this Medicare article:

• New specialty pharmacy medical step therapy requirements

Connecticut Teachers’ Retirement Board Offers Medicare Advantage Option

2020 Medicare risk adjustment provider trainings

MA home health network to be delegated to myNEXUS

AIM Musculoskeletal program expansion

Medication adherence incentive offered to EPHC providers

Postponed - Review of professional claims with emergency room level 5 E/M codes

Medical drug benefit Clinical Criteria updates

Keep up with Medicare news

Medicare Advantage Outpatient Rehabilitation Program transition information

Provider data update

Reimbursement Policy Update: Modifier 62: Co-Surgeons (Effective 05/01/2020)

Waived copays, deductibles and coinsurance for CCM, complex CCM and TCM

Reimbursement Policy Update: Multiple and Bilateral Surgery: Professional and Facility Reimbursement (Policy 06-010, effective 05/01/20)

Notify us of telehealth services

General Building Laborers' Local 66 Welfare Fund offers Medicare Advantage option

Keep up with Medicare news

In-office assessment program

Keep up with Medicare news

Oncology dose reduction program beginning July 1, 2021

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

Introducing a new clinical criteria web page for injectable, infused or implanted drugs covered under the medical benefit

Dual Eligible Special Needs Plans - provider training required

Change to 835 ERA for all D-SNP MA members for 2019

Clinical criteria updates for specialty pharmacy

The Anthem, Inc. name is changing

Keep up with Medicare news

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

Medical drug benefit clinical criteria updates – November 2020

Reimbursement Policy Update: Inpatient Readmissions

Reminder to Medicare Advantage providers

Attention facilities: Sending admission, discharge and transfer data to Empire results in improved care management for patients

Clinical Criteria updates

Blue Cross and Blue Shield Association mandate about Medicare Advantage care management and provider engagement

Medical drug benefit clinical criteria updates – December 2020

Let’s Vaccinate

Model of Care required training

City of Cincinnati Retirement System to offer Medicare Advantage option

New reimbursement policy: Modifier 90: Reference (Outside) Laboratory and Pass-Through Billing (Effective 10/01/21)

The impact of listening

East End Health Plan offers Medicare Advantage option

Prior authorization requirement changes effective October 1, 2021, for codes A0426 and A0428

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

Provider training series

Medical drug benefit Clinical Criteria updates

Keep up with Medicare News

New provider directory indicator for telehealth services

Medical Policies and Clinical Utilization Management Guidelines update

Access to more claim denial information is now self-service

Keep up with Medicare news

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

Introducing Interactive Care Reviewer - an online prior authorization tool

Keep up with Medicare news - September 2021

• Clinical Criteria Updates Notification May 2021

Empire working with Optum to collect medical records for risk adjustment