New York
Provider Communications

August 2018 Empire Provider Newsletter

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Title	Category
Update to AIM Radiation Oncology Clinical Appropriateness Guidelines	Products & Programs
Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines	Products & Programs
Updates to AIM Level of Care Musculoskeletal Surgery Clinical Appropriateness Guidelines	Products & Programs
Empire engages with Alliant Health Solutions	Behavioral Health
New Eating Disorder Service Available to Empire Members	Behavioral Health
Empire expands specialty pharmacy prior authorization list	Pharmacy
Empire expands specialty pharmacy clinical site of care (level of care) drug list	Pharmacy
Empire removes drugs from specialty pharmacy clinical site of care	Pharmacy
Empire to update drug lists supporting commercial health plans	Pharmacy
Empire accepts prior authorization requests for prescription medications online	Pharmacy
Empire applies daily morphine equivalent dosing limit	Pharmacy
Pharmacy information available on empireblue.com	Pharmacy
Attention: Updated or New Fee Schedules for Commercial products	Administrative
New precertification requirement for EGD services begins November 1, 2018	Administrative
Empire to enhance automated claim edits for professional claims	Administrative
Member Explanation of Benefits gets a makeover	Administrative
Important billing update for professional delivery claims	Administrative
Online Authorizations through the Availity Portal on Interactive Care Reviewer	Administrative
Empire transitioning to Availity EDI Gateway	Administrative
Webinar: Introduction to Availity EDI Gateway services for Empire provider organizations	Administrative
New pregnancy notification process using the Availity Web Portal Benefit Look-up Tool	Administrative
Important information about billing colonoscopy and related anesthesia services	Administrative
MyDiversePatients.com: A website to support your diverse patients	Administrative
Additional Support Available for Members with Rare Conditions	Administrative
Provider Transparency Update	Administrative
Vaginal Birth after Cesarean (VBAC) Certified Shared Decision Making Aid Available on the Web	Administrative
Policy Updates	Policy Updates
Medical Policy Updates	Medical Policy & Clinical Guidelines
Clinical Guideline Updates	Medical Policy & Clinical Guidelines
Review medical policy and clinical guidelines when referring services to a facility	Medical Policy & Clinical Guidelines
Update to Venipuncture Services Medical Policy effective March 1, 2018	Medical Policy & Clinical Guidelines
Archived medical policy	Medical Policy & Clinical Guidelines
Reimbursement Policy Updates	Reimbursement Policies
Making a change for the better - FEP system migration information	Federal Employee Plan (FEP)
MA members receive incentives for completing screenings	Medicare
DME providers and physicians: important wheelchair prior authorization information	Medicare
Submit PA medication requests electronically; new phone number for MA prescription PAs effective Sept. 1	Medicare
CMS issues regulatory changes for short- and long-acting narcotics; days’ supply limits effective Jan. 1, 2019	Medicare
MyDiversePatients.com addresses health care disparities	Medicare
Keep up with Medicare news	Medicare
Electronic Data Interchange migration to Availity	Medicaid
New pregnancy notification process using the Availity Portal Benefit Look-Up tool	Medicaid
Normal newborn diagnosis-related group claims processing update	Medicaid
Prior authorization requirements for Cabazitaxel (Jevtana)	Medicaid
Prior authorization requirements for injectable/infusible drugs: mepolizumab (Nucala) and reslizumab (Cinqair)	Medicaid
Coding Spotlight - Obesity	Medicaid
Reimbursement Policy Update: Medical Recalls	Medicaid
New HEDIS/QARR measures for 2018	Medicaid
Home- and community-based services for Health and Recovery Plan beneficiaries	Medicaid
Important information about utilization management	Medicaid
Member’s Rights and Responsibilities Statement	Medicaid

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