New York
Provider Communications

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Article order 3 - Step therapy update

Article Order 4 and Bullet Test - Beacon Health Options

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Shine Light on Depression: school-based suicide prevention initiative

Pharmacy Prior Authorization processing to transition to Empire's Pharmacy Benefit Manager: IngenioRx, Inc.

Empire to update formulary lists for commercial health plan pharmacy benefit

Clinical Criteria updates for specialty pharmacy are available

NYSHIP (New York State Health Insurance Program) change in immunization claim submissions

Empire SOAP Notes/Health Assessments for 2019 calendar year are due February 15, 2020

Medical Policy and Clinical Guideline updates

Updates to AIM Musculoskeletal Program Clinical Appropriateness Guidelines

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines

Clinical Laboratory Improvements Amendments for Empire

Reimbursement Policy Update: Early and Periodic Screening, Diagnosis and Treatment (EPSDT) (Effective 05/01/20)

Resources to support your diverse patient panel

Non-covered codes for Medicaid Managed Care (MMC) providers

Keep up with Medicaid news

Postponed - Review of professional claims with emergency room level 5 E/M codes

Medicare Advantage Outpatient Rehabilitation Program transition information

Reimbursement Policy Update: Modifier 62: Co-Surgeons (Effective 05/01/2020)

Reimbursement Policy Update: Multiple and Bilateral Surgery: Professional and Facility Reimbursement (Policy 06-010, effective 05/01/20)

General Building Laborers' Local 66 Welfare Fund offers Medicare Advantage option

Keep up with Medicare news

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Please continue to check Important Medicare Advantage Updates at empireblue.com/medicareprovider for the latest Medicare Advantage information.

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Anthem hosted a provider webinar to share information and resources with its network providers regarding opportunities providers have to access loans through the U.S Small Business Administration (SBA) and other federal programs in response to the economic impact of COVID-19. Access the webinar recording using the password “health” to learn more about federal financial relief for providers.

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Important COVID-19 update: Prior authorization and other policy adjustments

Thank you for your unwavering commitment and dedication to serving the patients in your care.  As the men and women at the forefront of the COVID-19 pandemic, we recognize and appreciate the efforts and sacrifices you are making across the country in the battle to defeat the virus.  We know that many of you are working long hours and are away from your families during this challenging time.  To support you, we’re working to ease your administrative burden, as you continue to focus on providing much needed health care to patients diagnosed with COVID-19.  To that end, Anthem is suspending select prior authorization rules. Unless otherwise required under state and federal mandates, Anthem health plans will suspend select prior authorization requirements, cost sharing and claims review, and handling protocols.   

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Interim Guidance and Updated FAQs for Providers regarding COVID-19

Information from Empire for Care Providers about COVID-19 - (Updated March 23, 2020)

Shine Light on Depression: school-based suicide prevention initiative

Pharmacy Prior Authorization processing to transition to Empire's Pharmacy Benefit Manager: IngenioRx, Inc.

Empire to update formulary lists for commercial health plan pharmacy benefit

Clinical Criteria updates for specialty pharmacy are available

NYSHIP (New York State Health Insurance Program) change in immunization claim submissions

Empire SOAP Notes/Health Assessments for 2019 calendar year are due February 15, 2020

Medical Policy and Clinical Guideline updates

Updates to AIM Musculoskeletal Program Clinical Appropriateness Guidelines

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines

Clinical Laboratory Improvements Amendments for Empire

Reimbursement Policy Update: Early and Periodic Screening, Diagnosis and Treatment (EPSDT) (Effective 05/01/20)

Resources to support your diverse patient panel

Non-covered codes for Medicaid Managed Care (MMC) providers

Keep up with Medicaid news

Postponed - Review of professional claims with emergency room level 5 E/M codes

Medicare Advantage Outpatient Rehabilitation Program transition information

Reimbursement Policy Update: Modifier 62: Co-Surgeons (Effective 05/01/2020)

Reimbursement Policy Update: Multiple and Bilateral Surgery: Professional and Facility Reimbursement (Policy 06-010, effective 05/01/20)

General Building Laborers' Local 66 Welfare Fund offers Medicare Advantage option

Keep up with Medicare news

New Musculoskeletal and Pain Management Solution Effective for Select National ASO Accounts January 1, 2020

Postponed: Review of professional claims with emergency room level 5 E/M codes

NYSHIP (New York State Health Insurance Program) change in Hyperbaric Oxygen Therapy claim submissions

The New Year brings New ID Cards for Many Empire Members

Appointment access standards for PCPs, specialty care and behavioral health practitioners

Availity providers can now receive and respond to medical record requests for post pay audit February 10, 2020

Upcoming retirement planned for legacy Medical Attachment submission tool

Let Us Help You Accomplish Your 2020 “To Do List” Early - EDI Migration

Remittance Inquiry Tool Reminder

Important Update: Milliman Care Guideline (MCG), 23rd Edition, ORG: W0163 Pelvic Organ Prolapse Repair

Reimbursement Policy update - Outpatient Facility Edit Implementation

2020 FEP Benefit information available online

Verifying and updating your provider information

Improving the patient experience

Medical drug benefit Clinical Criteria updates - August 2019

Medical drug benefit Clinical Criteria - September 2019

Medical Policies and Clinical Utilization Management Guidelines update

Coding spotlight - provider’s guide to coding respiratory diseases

Verifying and updating your provider information

Reminder: Medicare claims for secondary payer must be submitted after the 30-day Medicare remittance period

Medicare preferred continuous glucose monitors

Help protect your patients by providing medical ID protection - best practices

Reminder to Medicare Advantage providers

Healthcare Quality Patient Assessment Form and Patient Assessment Form

Medical drug benefit Clinical Criteria updates

Electric Boat offers Medicare Advantage options

Keep up with Medicare News

REMINDER: New AIM Rehabilitative Program effective November 1, 2019

Specialty Pharmacy Program expands Level of Care Reviews to NYC Hospital PPO Members

Case Management Program

Pharmacy information available on empireblue.com

Clinical Criteria updates for specialty pharmacy are available

2020 Network Changes

Announcing a New Network - Connection

Blue Access Expands to Include Large Groups

New - Individual Network

Verifying and updating your provider information

Coding Tip for Psychological and Neuropsychological Testing

Empire Works to Simplify Payment Recovery Process for National Accounts Membership

Empire BCBS HealthPlus to be removed from Availity’s Payer Menu

Retrieve your Empire Patient’s HEDIS® care gaps through Patient360 located on the Availity Portal

Coordination of Care