New York
Provider Communications

February 2023 Newsletter

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Title	Category
AIM Specialty Health will transition to Carelon Medical Benefits Management Inc.	Administrative
City of Manchester Offers Medicare Advantage Option	Medicare
Clinical Criteria updates for specialty pharmacy Material Adverse Change (MAC)	Pharmacy
Controlling High Blood Pressure and Submitting Compliant Readings	Administrative
Enhancing Provider News website and email communications	Digital Tools
Have you reviewed your online provider directory information lately?	Administrative
Helping to reduce delays when submitting attachments: Make sure your correspondence includes one of these elements	Digital Tools
Keep up with Medicaid news - February 2023 View these Medicaid articles:	Medicaid
Keep up with Medicare news - February 2023 View these Medicare articles: Introducing the Provider Learning Hub Empire BlueCross expands specialty pharmacy precertification list (Fylnetra) Empire BlueCross expands specialty pharmacy precertification list (Spevigo, Xenpozyme) Specialty pharmacy precertification list expansion (Rolvedon, Stimufend) New specialty pharmacy medical step therapy requirements (Infed, Injectafer, Monoferric) AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update Prior authorization requirement changes effective April 1, 2023 Medical Policies and Clinical Utilization Management Guidelines update Revised program implementation date prior authorizations for post-acute care Updates to AIM Specialty Health Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines Name change announcement: myNEXUS will transition to Carelon Post Acute Solutions on March 1, 2023	Medicare
Medical Policy and Clinical Guideline updates Material Adverse Change (MAC)	Medical Policy & Clinical Guidelines
Mutual of America New York moves to the Empire BlueCross BlueShield retiree solutions Medicare Advantage plan	Medicare
New policy for clinical data sharing and ADT notifications Material Adverse Change (MAC)	Administrative
Participating provider contractual obligations: Advanced patient notice policy for non-participating provider referrals	Administrative
Specialty pharmacy updates - February 2023 Material Adverse Change (MAC)	Pharmacy
Update: AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List	Medical Policy & Clinical Guidelines

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