New York
Provider Communications

Alcohol use disorders often coexist with psychiatric disorders

Webinars for New York Department of Health behavioral health carve-in for Medicaid Advantage Plus

Keep up with Medicaid news - November 2022

• Medical drug benefit Clinical Criteria updates
• Prior authorization requirement changes effective November 1, 2022

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)

Register for our upcoming CME webinar about low back pain management

Physician Office Lab (POL) List - October updates postponed

Monkeypox and smallpox vaccines: Product code on claims

Precertification list change

National Accounts 2023 Pre-certification list

CAA: Review your online provider directory information

The Provider Learning Hub is here

IngenioRx will become CarelonRx on January 1, 2023

Specialty pharmacy updates - October 2022

Clinical Criteria updates for specialty pharmacy

Pharmacy information available on empireblue.com

Reimbursement policy update: Three-Dimensional (3D) Radiology Services - Professional and Facility

Reimbursement policy update: Multiple and Bilateral Surgery Processing - Professional

Availity Provider Chat - a fast, easy way to get your UM questions answered for Federal Employees

Webinars for New York Department of Health behavioral health carve-in for Medicaid Advantage Plus

Monkeypox resources and recommendations for our care providers

Members’ Rights and Responsibilities

Complex Case Management program

Flu vaccination reimbursement

Reimbursement Policy Retraction: Sexually Transmitted Infections Testing (Professional)

Keep up with Medicaid news - October 2022

• Prior authorization updates for medications billed under the medical benefit – effective 11/1/22
• Prior authorization updates for medications billed under the medical benefit – effective 12/1/22
• New specialty pharmacy medical step therapy requirements

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

Continuing to explore the intersection of race and disability

Continuing to explore the intersection of race and disability

Monkeypox resources and recommendations for our care providers

New patient evaluation and management services when reported for the same patient within the last three years

Drug code billing reminder

Important information about women’s preventive care visits

Empire to accept Hospital in Home services

CAA: Current provider directory information is key for members and providers to engage with you seamlessly

Updates to the Claim Attachment workflow

New Back Pain Management Program

Specialty pharmacy updates - September 2022

Clinical Criteria updates for specialty pharmacy

Update to formulary lists for Commercial health plan pharmacy benefit

Reimbursement policy update - Modifier Rules (Professional)

Reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) (Professional)

Reimbursement policy update - Modifier 66: Surgical Teams (Professional)

OBRA 93 claim filing for Federal Employee Program

Reimbursement policy update: Modifiers 25 and 57: Evaluation and Management with Global Procedures (Policy G- 06003), (Informational only)

Clinical Criteria updates

New specialty pharmacy medical step therapy requirements

Enhancing claims attachment processes through digital applications

Alcohol use disorders linked to chronic diseases

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

Correction: Physician Office Lab list updates effective October 1, 2022

Timely updates help keep our provider directories current

Introducing the Provider Learning Hub

Add supporting documents directly to your claims with the new Claims Status Send Attachments feature

Performance enhancements to the authorization application on Availity Essentials

Telehealth visits can impact after-hospitalization follow-up care for mental illness

Specialty pharmacy updates

Clinical Criteria updates for specialty pharmacy

Pharmacy information available online

Medical Policy and Clinical Guideline updates

HEDIS 2022: Summary of changes from NCQA

Chlamydia screening

Using SBIRT to address opioid and substance use disorders

The cost of alcohol use disorder

Prior authorization requirement changes updated effective date November 1, 2022

Prior authorizations for post-acute care

Empire expands specialty pharmacy precertification list

Join us for our next clinical quality in practice webinar

Reimbursement policy update: Laboratory and Venipuncture Services - Professional & Facility

Material Adverse Change (MAC)

Reimbursement policy update: Distinct Procedural Service, Modifiers 59 and XE, XP, XS, and XU - professional

Material Adverse Change (MAC)

New reimbursement policy: Transitional Care Management - professional

Retraction for reimbursement policy — Sexually Transmitted Infections - professional

New reimbursement policy: Place of Service - facility

Radiology prior authorization review transitioning to AIM

Prior authorization requirement changes effective August 1, 2022

MCG care guidelines 26th edition

Update to electronic verification visit key points

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

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

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

Physician Office Lab Listing - updates effective August 1, 2022

Provider manual updated effective October 1, 2022

Introducing Elevance Health - Focusing on whole health and its most powerful drivers

Help patients heal from the comfort of home with Hospital in Home care

Updates to edits associated with implants

Enhanced reimbursement for voluntary Cancer Care Quality program to be discontinued effective December 31, 2022