New York
Provider Communications

November 2019 Empire Provider News

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Title	Category
Reminder about AIM’s new Rehabilitative Program effective November 1, 2019	Products & Programs
Remaining members will transition to new PBM, IngenioRx, on January 1, 2020	Pharmacy
Prior authorization updates for specialty pharmacy are available	Pharmacy
Clinical Criteria updates for specialty pharmacy are available	Pharmacy
Changes to timely filing requirements for Commercial plans for all claims submitted to plan on or after October 1, 2019	Administrative
Additional improvements coming to empireblue.com	Administrative
Appropriate coding helps provide a comprehensive picture of patients’ health	Administrative
Medical Policy & Clinical Guideline updates	Medical Policy & Clinical Guidelines
Updates to AIM Advanced Imaging of the Abdomen and Pelvis Clinical Appropriateness Guideline	Medical Policy & Clinical Guidelines
Updates to AIM Radiation Therapy Clinical Appropriateness Guideline	Medical Policy & Clinical Guidelines
Updates to AIM Spine Surgery Clinical Appropriateness Guideline	Medical Policy & Clinical Guidelines
Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline	Medical Policy & Clinical Guidelines
Electronic submission is preferred method for requesting pharmacy prior authorization	Medicaid
Reimbursement Policy Update: Early and Periodic Screening, Diagnosis and Treatment (EPSDT)	Medicaid
Keep up with Medicaid news	Medicaid
Electronic submission is preferred method for requesting pharmacy prior authorization	Medicare
CMS reminder: expedited/urgent requests	Medicare
Blue Cross and Blue Shield Association mandate about Medicare Advantage care management and provider engagement	Medicare
Keep up with Medicare news	Medicare

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