New York
Provider Communications

July 2021 Newsletter

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Title Category

AIM Rehabilitative program - initial evaluations and site of service reviews

Products & Programs

Another mark of the pandemic: an increase in childhood obesity

Administrative

Attention facilities: Sending admission, discharge and transfer data to Empire results in improved care management for patients

Medicaid

Attention facilities: Sending admission, discharge and transfer data to Empire results in improved care management for patients

Medicare

Blue Precision program to be retired at the end of the year

Products & Programs

Certain specialty medication precertification requests may require additional documentation

Pharmacy

Certain specialty medication precertification requests may require additional documentation

Medicaid

Clinical Criteria updates for specialty pharmacy

Material adverse change (MAC) notification
Pharmacy

Coding spotlight: mental disorders in childhood

Medicaid

Commercial Repapering: Important update

Administrative

Designated specialty pharmacy network updates effective October 1, 2021

Material adverse change (MAC) notification
Pharmacy

Electronic claim response files

Digital Tools

Federal Employee Program® AIM Radiology prior authorization review

Material adverse change (MAC) notification
Federal Employee Plan (FEP)

How to enroll in electronic fund transfer (EFT) for faster remittance

Digital Tools

Interactive Care Reviewer (ICR): New search option for cases submitted through ICR

Digital Tools

Keep up with Medicaid news

Medicaid

Let’s Vaccinate

Medicaid

Let’s Vaccinate

Medicare

Medical drug benefit Clinical Criteria updates

Medicaid

Medical drug benefit Clinical Criteria updates

Medicare

Medical policy updates and clinical guideline updates

Material adverse change (MAC) notification
Medical Policy & Clinical Guidelines

New reimbursement policy: Modifier 90: Reference (Outside) Laboratory and Pass-Through Billing (Effective 10/01/21)

Medicaid

New reimbursement policy: Modifier 90: Reference (Outside) Laboratory and Pass-Through Billing (Effective 10/01/21)

Medicare

New reimbursement policy: Non-patient Laboratory Services (Facility)

Material adverse change (MAC) notification
Reimbursement Policies

Prior authorization requirement changes effective October 1, 2021, for codes A0426 and A0428

Medicare

Prior authorization requirement changes effective September 1, 2021

Medicaid

Proper coding for in-home monitoring can make a measurable difference for INR

Administrative

Register now to learn strategies to help you and your practice improve clinical quality

Administrative

Reimbursement policy update: Consultations (Professional)

Material adverse change (MAC) notification
Reimbursement Policies

Resources to support your diverse patient panel

Medicaid

Retraction: AIM Rehabilitative program — initial evaluations and site of service reviews

Medicaid

Surgical Clinical Site of Care review updates

Administrative

Timely receipt of primary payer’s EOB can help reduce timely filing denials for secondary claims

Administrative

Update: Site of Care medical necessity reviews for long-acting colony-stimulating factors will not be implemented on August 1, 2021

Material adverse change (MAC) notification

Products & Programs

Updates for specialty pharmacy are effective October 1, 2021

Material adverse change (MAC) notification
Pharmacy

Updates to AIM Specialty Health Musculoskeletal program clinical appropriateness guidelines

Medicaid

What Matters Most: Improving the Patient Experience

Medicaid
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