New York
Provider Communications

October 2022 Newsletter

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Title Category

Availity Provider Chat - a fast, easy way to get your UM questions answered for Federal Employees

Federal Employee Plan (FEP)

CAA: Review your online provider directory information

Administrative

Clinical Criteria updates for specialty pharmacy

Material Adverse Change (MAC)
Pharmacy

Complex Case Management program

Medicaid

Courtesy notification of specialty pharmacy medical step therapy updates

Medicare

Flu vaccination reimbursement

Medicaid

IngenioRx will become CarelonRx on January 1, 2023

Pharmacy

Keep up with Medicaid news - October 2022

View these Medicaid articles:
  • Prior authorization updates for medications billed under the medical benefit – effective 11/1/22
  • Prior authorization updates for medications billed under the medical benefit – effective 12/1/22
  • New specialty pharmacy medical step therapy requirements
Medicaid

Keep up with Medicare news - October 2022

View these Medicare articles:
  • Empire BlueCross BlueShield expands specialty pharmacy precertification list
  • Empire BlueCross BlueShield expands specialty pharmacy precertification list 
  • Consultation codes
Medicare

Medicare telehealth services during the Coronavirus (COVID-19) public health emergency (PHE) FAQ

Medicare

Members’ Rights and Responsibilities

Medicaid

Monkeypox and smallpox vaccines: Product code on claims

Administrative

Monkeypox resources and recommendations for our care providers

Medicaid

National Accounts 2023 Pre-certification list

Administrative

Pharmacy information available on empireblue.com

Pharmacy

Physician Office Lab (POL) List - October updates postponed

Administrative

Precertification list change

Material Adverse Change (MAC)
Administrative

Reimbursement Policy Retraction: Sexually Transmitted Infections Testing (Professional)

Medicaid

Reimbursement Policy Retraction: Sexually Transmitted Infections Testing (Professional)

Medicare

Reimbursement policy update: Multiple and Bilateral Surgery Processing - Professional

Material Adverse Change (MAC)
Reimbursement Policies

Reimbursement policy update: Three-Dimensional (3D) Radiology Services - Professional and Facility

Material Adverse Change (MAC)
Reimbursement Policies

Specialty pharmacy updates - October 2022

Material Adverse Change (MAC)
Pharmacy

The Provider Learning Hub is here

Digital Tools

Webinars for New York Department of Health behavioral health carve-in for Medicaid Advantage Plus

Medicaid

Webinars for New York Department of Health behavioral health carve-in for Medicaid Advantage Plus

Medicare
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