New York
Provider Communications

December 2018 Empire Provider Newsletter

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Title	Category
Empire accepts electronic prior authorization requests for prescription medications online	Pharmacy
Introducing the new Clinical Criteria page for injectable, infused or implanted drugs	Pharmacy
Pharmacy information available on empireblue.com	Pharmacy
Empire announces a new network - Blue Access	Administrative
Empire announces changes to the Individual Health Benefit Plans	Administrative
Prepare NOW for Empire Facility and Physician Portal Retirement	Administrative
Availity to serve as EDI entry point for electronic submissions	Administrative
Explore new enhancements to the Education and Reference Center	Administrative
Company works to simplify payment recovery process for National Accounts membership	Administrative
HEDIS® 2018 Commercial Results Are In	Administrative
Case Management Program	Administrative
ConditionCare Program Benefits Patients and Physicians	Administrative
Integrated Care Model for plans purchased on the Health Insurance Marketplace benefits patients and physicians	Administrative
Coordination of Care	Administrative
Important Information about Utilization Management	Administrative
Members’ Rights and Responsibilities	Administrative
Vaginal Birth after Cesarean (VBAC) Certified Shared Decision Making Aid Available on the Web	Administrative
Clinical practice and preventive health guidelines available online	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 AIM Clinical Appropriateness Guidelines	Medical Policy & Clinical Guidelines
Updates to AIM Musculoskeletal Surgery Clinical Appropriateness Guidelines	Medical Policy & Clinical Guidelines
Restructure of AIM Advanced Imaging Clinical Appropriateness Guidelines	Medical Policy & Clinical Guidelines
Reimbursement Policy Updates	Reimbursement Policies
Reimbursement for Convenience Surgical Supply Kits - Professional	Reimbursement Policies
Bundled Services and Supplies - Professional	Reimbursement Policies
Reimbursement Policy Update - Scope of License (Professional)	Reimbursement Policies
Coordination of Benefits for an FEP member	Federal Employee Plan (FEP)
Benefit change for Infliximab for Federal Employee Program	Federal Employee Plan (FEP)
2019 FEP Benefit information available online	Federal Employee Plan (FEP)
New Medicare Advantage provider service phone number beginning January 1, 2019	Medicare
2019 Medicare Advantage individual benefits and formularies	Medicare
CMS Medicare Preclusion List effective April 1, 2019	Medicare
When and how to initiate Medicare Advantage reopenings	Medicare
Individual Medicare plans move compound drugs off formulary beginning January 1, 2019	Medicare
Medicare Part B drugs may include Step Therapy beginning January 1, 2019	Medicare
MediBlue Select HMO Network expands effective January 1, 2019	Medicare
Medical Policies updated	Medicare
Keep up with Medicare news	Medicare
Electronic data interchange gateway update	Medicaid
Empire HealthPlus adopts MCG Care Guidelines for clinical reviews of mental health services	Medicaid
Prior authorization requirements for Sublocade	Medicaid
Prior authorization requirements for Subcutaneous Implantable Defibrillator system	Medicaid
UPDATE: Prior authorization requirements for high-level, definitive drug testing delayed	Medicaid
Viral suppression rates improve in patients with HIV in the US,while disparities continue to exist	Medicaid
Reimbursement Policy Update: Claims Requiring Additional Documentation (Policy 06-031, effective 03/01/19)	Medicaid
Transition of Outpatient Rehabilitation Utilization Management Program effective January 1, 2019	Medicaid
Medical Policies and Clinical Utilization Management Guidelines update	Medicaid
Coding spotlight: substance use disorders and smoking	Medicaid
Pharmacy management information	Medicaid
Practitioners’ rights during credentialing process	Medicaid

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