New York
Provider Communications

October 2018 Empire Provider Newsletter

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Title	Category
Empire expands specialty pharmacy prior authorization list	Pharmacy
Empire Expands specialty pharmacy clinically equivalent drug list	Pharmacy
Empire expands specialty pharmacy level of care (clinical site of care) drug list	Pharmacy
Empire accepts prior authorization requests for prescription medications online	Pharmacy
Access patient-specific drug benefit information through EMR	Pharmacy
Pharmacy information available on empireblue.com	Pharmacy
Attention: Updated or New Fee Schedules for Commercial products - REVISED DATE	Administrative
Empire launches additional changes to empireblue.com in October	Administrative
Electronic Member ID Cards: Online option available on Availity	Administrative
What Matters Most: Improving the Patient Experience	Administrative
Special Investigations Unit Updates	Administrative
HEDIS® 2018: Provider Incentive Winners Announced!	Administrative
Integrated Medical and Behavioral Healthcare Services	Administrative
Availity as Empire’s EDI Gateway	Administrative
Availity EDI Gateway Webinars Scheduled	Administrative
Empire fights opioid addiction: Extension for Community Healthcare Outcomes and Quality Medication-Assisted Therapy	Administrative
Tips for billing CPT modifier 33	Administrative
Update to Durable Medical Equipment – effective October 14, 2018	Administrative
Policy Updates	Policy Updates
Medical Policy Updates	Medical Policy & Clinical Guidelines
Clinical Guideline Updates	Medical Policy & Clinical Guidelines
Review medical policy and clinical guidelines when referring services to a facility	Medical Policy & Clinical Guidelines
Update to AIM Specialty Health radiation oncology clinical appropriateness guidelines	Medical Policy & Clinical Guidelines
Update to AIM Specialty Health clinical appropriateness guidelines: advanced imaging appropriate use criteria: imaging of the heart	Medical Policy & Clinical Guidelines
Update to AIM Specialty Health sleep disorder management clinical appropriateness guidelines	Medical Policy & Clinical Guidelines
Reimbursement Policy Updates	Reimbursement Policies
Reimbursement Policy Update - Readmissions (Facility)	Reimbursement Policies
New Reimbursement Policy - Facility Revenue Code Billing (Facility)	Reimbursement Policies
Genetic testing prior authorization by ordering physician helps ensure accurate lab payment	Medicare
Empire transitions MA back pain management and cardiology UM programs from OrthoNet to AIM	Medicare
Please evaluate statin use for MA members with diabetes, cardiovascular disease	Medicare
Medicare pharmacy and prescriber home starts January 2019	Medicare
Group sponsored Medicare Advantage plan members to receive new ID cards	Medicare
Keep up with Medicare news	Medicare
EDI Gateway migration	Medicaid
Empire Fights opioid addiction: Extension for Community Health Care Outcomes and Quality Medication-Assisted Therapy	Medicaid
Vaginal birth after cesarean shared decision-making aid available	Medicaid
Cervical length measurement by transvaginal ultrasound	Medicaid
Prior authorization requirements for high-level, definitive drug testing	Medicaid
Prior authorization requirements for Interferon beta-1a	Medicaid
Prior authorization requirements for Somatrem	Medicaid
Medical Policies and Clinical Utilization Management Guidelines update: effective 1/25/18	Medicaid
Medical Policies and Clinical Utilization Management Guidelines update: effective 3/22/18	Medicaid
Medical Policies and Clinical Utilization Management Guidelines update: effective 11/1/18	Medicaid

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