New York
Provider Communications

June 2018 Empire Provider Newsletter

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Title	Category
Important Update: June 15, 2018 - Access to the Empire Facility / Professional Secure Portals Only on the Availity Portal	Administrative
Availity is now our designated EDI Gateway	Administrative
Introducing Interactive Care Reviewer for Online Authorizations	Administrative
Empire streamlines member identification cards	Administrative
Updated Provider Manual now available	Administrative
Receive Direct Deposit of Patient Payments with Healthcare Bill Payments	Administrative
Reminder: Miscellaneous durable medical equipment billing guideline:	Administrative
Update to claim processing for services requiring AIM prior authorization	Products & Programs
Updates to AIM Musculoskeletal Program Clinical Appropriateness Guidelines	Products & Programs
Coverage Guideline not implemented - Cervical Cancer Screening Using Cytology and Human Papillomavirus Testing (CG-MED-53)	Products & Programs
Empire expands Specialty Pharmacy Clinical Site of Care (Level of Care) drug list	Pharmacy
Empire expands specialty pharmacy prior authorization list	Pharmacy
Reminder: Empire accepts prior authorization requests for prescription medications online	Pharmacy
Pharmacy information available on empireblue.com/provider	Pharmacy
Verifying eligibility for expanded hospice benefits	Products & Programs
Empire’s Individualized Care Program to support palliative care for commercial members	Products & Programs
Empire Adopts MCG Care Guidelines for Behavioral Health Services	Behavioral Health
Outpatient visits	Behavioral Health
Policy Updates	Policy Updates
Medical Policy Updates	Medical Policy & Clinical Guidelines
Clinical Guideline Updates	Medical Policy & Clinical Guidelines
Professional Reimbursement Policy Update	Reimbursement Policies
Reimbursement Policy Reminder - Durable Medical Equipment (Professional)	Reimbursement Policies
Making a change for the better - FEP® system migration information	Federal Employee Plan (FEP)
Cologuard covered for Medicare Advantage	Medicare
Peer-to-peer process can help clarify clinical record	Medicare
Motion Picture Industry Pension and Health Plans Offers Medicare Advantage Option	Medicare
Connecticut Teachers’ Retirement Board Offers Medicare Advantage Option	Medicare
MA home health network to be delegated to myNEXUS	Medicare
Medication adherence incentive offered to EPHC providers	Medicare
Keep up with Medicare news	Medicare
Empire to conduct post-payment reviews of distinct procedural services modifiers	Medicaid
Miscellaneous durable medical equipment billing guidelines	Medicaid
Prior authorization requirement update for Mylotarg (gemtuzumab ozogamicin)	Medicaid
Electrical stimulation device to require prior authorization	Medicaid
Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service	Medicaid
Lower extremity vascular intervention codes require prior authorization	Medicaid
Prior authorization requirements for Darzalex (daratumumab) drug	Medicaid
Services requiring prior authorization	Medicaid
Medical Policies and Clinical Utilization Management Guidelines update	Medicaid
Behavioral health network provider training	Medicaid
Behavioral health Discharge Action Plan: improving care transitions	Medicaid
Provider surveys	Medicaid
Use the Provider Maintenance Form to update your information	Medicaid
Complex Case Management program	Medicaid
What Matters Most: Improving the Patient Experience	Medicaid
Coding Spotlight: Pregnancy, A provider’s guide to diagnose and code for pregnancy	Medicaid

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