New York
Provider Communications

July 2019 Empire Provider News

Title	Category
Pharmacy Benefit Manager Change	Pharmacy
Clinical criteria updates for specialty pharmacy	Pharmacy
Clinical Criteria coding updates for specialty pharmacy are available	Pharmacy
Clinical Validation - Professional	Administrative
Changes to timely filing requirements for Medicare Advantage	Administrative
Make the move to the Availity EDI Gateway today	Administrative
CRA Reporting Update: 2019 Program Year Progression - What’s in it for you and your patients?	Administrative
Empire Works to Simplify Payment Recovery Process for National Accounts Membership	Administrative
Un-adopted clinical guidelines effective June 1, 2019	Medical Policy & Clinical Guidelines
Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines	Medical Policy & Clinical Guidelines
Reimbursement Policy updates	Reimbursement Policies
Empire Federal Employee Health Benefit Program® (FEP) PPO Members will now require prior approval for specific Specialty Drugs and Site of Care	Federal Employee Plan (FEP)
Medicare Advantage: Electronic claim payment reconsideration	Medicare
Medicare Advantage: Sepsis diagnosis coding and billing reminder	Medicare
Home health billing guidelines for contracted providers	Medicare
Medical Policies and Clinical Utilization Management Guidelines update	Medicare
Keep up with Medicare news	Medicare
New service types added to Availity	Medicaid
Electronic claim payment reconsideration	Medicaid
Trauma-informed care	Medicaid
Sepsis diagnosis coding and billing reminder	Medicaid
Unspecified diagnosis code update	Medicaid
Coding Spotlight: Hypertension, A providers’ guide for coding	Medicaid
Health Homes - a valuable provider of community-based care coordination	Medicaid
Reimbursement Policy Update: Multiple Radiology Payment Reduction (Policy 12-002)	Medicaid
Pharmacy benefit manager change	Medicaid
New York City Department of Health advisory: HIV outbreak risk factors are present in New York City	Medicaid

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New York
Provider Communications

July 2019 Empire Provider News

Pharmacy Benefit Manager Change

Clinical criteria updates for specialty pharmacy

Clinical Criteria coding updates for specialty pharmacy are available

Clinical Validation - Professional

Changes to timely filing requirements for Medicare Advantage

Make the move to the Availity EDI Gateway today

CRA Reporting Update: 2019 Program Year Progression - What’s in it for you and your patients?

Empire Works to Simplify Payment Recovery Process for National Accounts Membership

Un-adopted clinical guidelines effective June 1, 2019

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines

Reimbursement Policy updates

Empire Federal Employee Health Benefit Program® (FEP) PPO Members will now require prior approval for specific Specialty Drugs and Site of Care

Medicare Advantage: Electronic claim payment reconsideration

Medicare Advantage: Sepsis diagnosis coding and billing reminder

Home health billing guidelines for contracted providers

Medical Policies and Clinical Utilization Management Guidelines update

Keep up with Medicare news

New service types added to Availity

Electronic claim payment reconsideration

Trauma-informed care

Sepsis diagnosis coding and billing reminder

Unspecified diagnosis code update

Coding Spotlight: Hypertension, A providers’ guide for coding

Health Homes - a valuable provider of community-based care coordination

Reimbursement Policy Update: Multiple Radiology Payment Reduction (Policy 12-002)

Pharmacy benefit manager change

New York City Department of Health advisory: HIV outbreak risk factors are present in New York City

New YorkProvider Communications

July 2019 Empire Provider News

New York
Provider Communications