New York
Provider Communications

December 2021 Newsletter

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Title	Category
Prepare for the Consolidated Appropriations Act: Keep your provider directory information up to date	Administrative
Facility option to receive verbal UM Notifications electronically	Administrative
Submitting prior authorizations is getting easier Empire is transitioning to the Availity Authorization app	Administrative
Is prior authorization required? Answering your questions about the new Availity Authorization app	Administrative
Chlamydia screening for teens and young adults	Administrative
Outpatient system updates for 2022	Administrative
Professional system updates for 2022	Administrative
Clinical practice and preventive health guidelines available on empireblue.com	Administrative
Coordination of care	Administrative
Member rights and responsibilities	Administrative
Important information about utilization management	Administrative
Case management program	Administrative
Importance of PCP after-hours messaging	Administrative
Behavioral healthcare appointment access requirements	Administrative
Reminder: The 32BJ Health Fund Centers of Excellence for Bariatric and Joint Replacement Surgery program begins January 1, 2022	Administrative
Reminder: EnrollSafe is available - electronic funds transfer enrollment portal for Empire providers EnrollSafe replaced CAQH Enrollhub effective November 1, 2021	Digital Tools
Utilization management tool available on Availity Payer Spaces: Authorization Rules Lookup tool	Digital Tools
Empire to retire Blue Precision program on December 31, 2021	Products & Programs
Clinical Criteria updates for specialty pharmacy Material Adverse Change (MAC)	Pharmacy
Specialty pharmacy updates - December 2021 Material Adverse Change (MAC)	Pharmacy
Pharmacy information available on empireblue.com	Pharmacy
Updates to AIM Specialty Health Musculoskeletal Interventional Pain Management clinical appropriateness guideline Material Adverse Change (MAC)	Medical Policy & Clinical Guidelines
Updates to AIM Specialty Health Cardiology clinical appropriateness guidelines Material Adverse Change (MAC)	Medical Policy & Clinical Guidelines
Updates to AIM Specialty Health Radiation Oncology clinical appropriateness guideline Material Adverse Change (MAC)	Medical Policy & Clinical Guidelines
Updates to AIM Advanced Imaging clinical appropriateness guideline Material Adverse Change (MAC)	Medical Policy & Clinical Guidelines
Reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) - professional Material Adverse Change (MAC)	Reimbursement Policies
New reimbursement policy update: Modifier 62: Co-Surgeon Services and Modifier 66: Surgical Teams - professional Material Adverse Change (MAC)	Reimbursement Policies
Reimbursement policy update: Virtual Visits - professional and facility	Reimbursement Policies
Reimbursement policy update: Drug Screen Testing (effective March 1, 2022)	Medicaid
Reimbursement policy update: Multiple and Bilateral Surgery - Professional and Facility (effective 03/01/22)	Medicaid
HEDIS measures: Follow-Up After ED Visits for Mental Illness and Alcohol and Drug Dependency	Medicaid
Claims editing update for ICD-10-CM Excludes1 notes	Medicaid
Updates to AIM Specialty Health Advanced Imaging clinical appropriateness guidelines	Medicaid
Medical Policies and Clinical Utilization Management Guidelines update	Medicaid
Good news: Non-payment remittance advice enhancements are here	Medicaid
Submitting prior authorizations is getting easier	Medicaid
Keep up with Medicaid news - December 2021 View these Medicaid articles: Durable medical equipment prior authorization requirement changes effective December 1, 2021 Cancer Care Navigator Medical drug benefit Clinical Criteria updates Prior authorization updates for medications billed under the medical benefit Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines Updates to AIM Specialty Health musculoskeletal interventional pain management clinical appropriateness guideline	Medicaid
City of New York GRS Alliance Program (Updated 12/3/21)	Medicare
Webinars for City of New York retirees transitioning to new Medicare Advantage plan (Updated 12/3/21)	Medicare
Reimbursement Policy Update: Drug Screen Testing (effective March 1, 2022)	Medicare
Updates to AIM Specialty Health Advanced Imaging clinical appropriateness guidelines	Medicare
2022 Medicare Advantage service area and benefit updates	Medicare
Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies	Medicare
Good news: Non-payment remittance advice enhancements are here	Medicare
Submitting prior authorizations is getting easier	Medicare
Keep up with Medicare news - December 2021 View these Medicare articles: Medical drug benefit Clinical Criteria updates FAQ: NYC Medicare Advantage Plus Protocol for providers serving members with hearing aid coverage administered by Hearing Care Solutions Medical Policies and Clinical Utilization Management Guidelines update Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines Updates to AIM Specialty Health musculoskeletal interventional pain management clinical appropriateness guideline	Medicare

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