New York
Provider Communications

March 2023 Empire Provider News

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Title	Category
Advancing Mental Health Equity for Youth & Young Adults	Administrative
Carelon Medical Benefits Management (formerly AIM Specialty Health) Radiology Clinical Appropriateness Guidelines CPT code list update Material Adverse Change (MAC)	Administrative
Clinical Criteria updates for specialty pharmacy Material adverse change (MAC)	Pharmacy
Consumer payment option, Pay Doctor Bill, to terminate effective March 31, 2023	Products & Programs
Controlling High Blood Pressure and Submitting Compliant Readings	Administrative
Controlling High Blood Pressure and Submitting Compliant Readings	Medicare
Group number change for Screen Actors Guild-American Federation of Television and Radio Artists Health Plan	Administrative
Informational Update: Modifier Usage (Policy G-06006)	Medicare
Keep up with Medicaid news - March 2023 View these Medicaid articles: Clinical Criteria updates Prior authorization updates for medications billed under the medical benefit (Carvykti) Updates to Carelon Medical Benefits Management, Inc. Cardiac Clinical Appropriateness Guidelines	Medicaid
Keep up with Medicare news - March 2023 View these Medicare articles: Updates to Carelon Medical Benefits Management, Inc. Cardiac Clinical Appropriateness Guidelines Carelon Medical Benefits Management, Inc. Genetic Testing Clinical Appropriateness Guidelines CPT code list update Clinical Criteria updates New specialty pharmacy medical step therapy requirements (Neulasta, Neulasta OnPro, Udenyca)	Medicare
March is National Colorectal Cancer Awareness Month	Administrative
Notice of assignment of your Empire Provider Agreement to Carelon (formerly Beacon)	Administrative
Pharmacy information available on our provider website	Pharmacy
Policy Update: Modifiers 25 and 57 (Policy G-06003, effective 04/01/2023) Material Adverse Change (MAC)	Medicaid
Reimbursement policy update: Modifiers 25 and 57 - Professional	Reimbursement Policies
Shared savings and transition care management after inpatient discharges	Medicare
Specialty pharmacy updates for March 2023 Material adverse change (MAC)	Pharmacy
Time to prepare for HEDIS medical record review	Administrative

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