New York
Provider Communications

Updates to AIM Specialty Health advanced imaging clinical appropriateness guidelines

Material Adverse Change (MAC)

Updates to AIM Specialty Health musculoskeletal clinical appropriateness guidelines

Updates to AIM Specialty Health sleep disorder management clinical appropriateness

Material Adverse Change (MAC)

Reimbursement policy update: Treatment Rooms with Office Evaluation and Management Services (Facility)

Material Adverse Change (MAC)

Process change for Federal Employee Program® third-party correspondence requests

Provider notice for COVID-19 testing

InterQual migration

Medical Policies and Clinical Utilization Management Guidelines update

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

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

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

Empire announces changes to post-payment audits conducted on our behalf

Action required: Conversion to a new reimbursement system for outpatient facility services

Coding tips for reporting administration of Spravato®

CAA: Timely updates help keep our provider directories current

Primary care appointment access and open panels

Resources to support diverse patients and communities

May is national high blood pressure education month: We’ve got this!

Alcohol use disorder has a big cost

Clinical Criteria updates for specialty pharmacy

Material Adverse Change (MAC)

Specialty pharmacy updates - May 2022

Medical policy and clinical guideline updates

Material Adverse Change (MAC)

Join us for an FEP Quality Learning program live webinar

CORRECTION: Save time tomorrow by using CPT II codes today: Introducing the FEP® Quality Reimbursement Program for PPO providers

Federal Employee Program® AIM radiology prior authorization review reminder

Screening for alcohol use disorder in high-prevalence demographics

New Strategic Provider System implementation May 2022

CPT Category II update

Keep up with Medicaid news- May 2022

View these Medicaid articles:

• Prior authorization requirement changes for HCPCS code K1022
• New specialty pharmacy medical step therapy requirements

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

Information from Empire for Care Providers about COVID-19 - RETIRED as of November 8, 2022

As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED.

Future updates regarding COVID-19 will appear in the monthly Provider News publication.

Improving antibiotic use for acute respiratory infections in the outpatient setting

The Anthem, Inc. name is changing

HEDIS 2022: Summary of changes from NCQA

Catching up on routine vaccines

CAA: Update your provider directory information

Procedure searches in Find Care

Importance of behavioral healthcare after-hours messaging

Specialty pharmacy updates - April 2022

Material Adverse Change (MAC)

Reminder on Botox® for Empire members

Pharmacy information available on empireblue.com

Save time by using CPT II codes: Introducing FEP Quality Reimbursement Program for PPO providers

The Anthem, Inc. name is changing

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

Reimbursement Policy Update: Inpatient Readmissions

Disease Management/Population Health program

Clinical Criteria updates

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

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

City of New York Retirees Transition to NYC Medicare Advantage Plus Delayed

The Anthem, Inc. name is changing

Exploring Implicit Bias in Healthcare for Historically Marginalized Communities

Register today for the Exploring Implicit Bias in Healthcare for Historically Marginalized Communities forum hosted by Empire and Motivo* for providers on March 16, 2022

CAA: Have you reviewed your online provider directory information lately?

New! Vaccination resource page for providers

Updated Preventive Care Guidance regarding screening colonoscopies

Your influence matters: recommending cancer screenings to your patients

Understanding your patients’ differences is lifesaving

Simplifying requests for additional information

Enhancements to the Availity Authorization application are now available

Clinical Criteria updates for specialty pharmacy

Correction to February 2022 specialty pharmacy updates

Specialty pharmacy updates – March 2022

AIM Specialty Health Outpatient Rehabilitative and Habilitative Services clinical appropriateness guidelines updates

Change to the Federal Employee Program® Clinical Grievance and Appeal Address

HEDIS 2022 Federal Employee Program® medical record request requirements

Required: Cultural competence training

It is CAHPS survey time!

Urinary tract infection toolkits are on the way

New Strategic Provider System will launch in April 2022

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

Prepare for the CAA: Keep your provider directory information current

Heart disease is the number one killer of women

It is CAHPS survey time!

Cancer Care Navigator

Clinical Criteria updates for specialty pharmacy

Material Adverse Change (MAC)

Specialty pharmacy updates - February 2022

Pharmacy information available on empireblue.com

Clarification to reimbursement policy update: Virtual Visits - Professional and Facility

Get faster payments with EFT

Get faster payments with EFT

City of New York Retirees will transition to NYC Medicare Advantage Plus offered through an alliance between Empire and EmblemHealth

Blue High Performance Network name changing for 2022