New York
Provider Communications

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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)

Resources to support your diverse patient panel

Clinical Laboratory Improvements Amendments for Empire

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

Shine Light on Depression: school-based suicide prevention initiative

Medicare Advantage Outpatient Rehabilitation Program transition information

Empire to update formulary lists for commercial health plan pharmacy benefit

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

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

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

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

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

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

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

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

Improving the patient experience

Remittance Inquiry Tool Reminder

2020 FEP Benefit information available online

Medical drug benefit Clinical Criteria updates

Electric Boat offers Medicare Advantage options

Medical drug benefit Clinical Criteria - September 2019

The New Year brings New ID Cards for Many Empire Members

Medical drug benefit Clinical Criteria updates - August 2019

Coding spotlight - provider’s guide to coding respiratory diseases

Reimbursement Policy update - Outpatient Facility Edit Implementation

Healthcare Quality Patient Assessment Form and Patient Assessment Form

Upcoming retirement planned for legacy Medical Attachment submission tool

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

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

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

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

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

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

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

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

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

2020 Network Changes

New - Individual Network

Provider training series

Announcing a New Network - Connection

System updates for 2020 - Professional

Reminder to Medicare Advantage providers

Blue Access Expands to Include Large Groups

Coordination of Benefits for an FEP® member

Verifying and updating your provider information

East End Health Plan offers Medicare Advantage option

Coding Tip for Psychological and Neuropsychological Testing

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

REMINDER: New AIM Rehabilitative Program effective November 1, 2019

City of Cincinnati Retirement System to offer Medicare Advantage option

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

Clinical practice and preventive health guidelines available on empireblue.com/provider

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

New Reimbursement Policy Durable Medical Equipment - Rent to Purchase and Durable Medical Equipment - Modifiers (Professional)

CMS reminder: expedited/urgent requests

Medical Policy & Clinical Guideline updates

Additional improvements coming to empireblue.com

Updates to AIM Spine Surgery Clinical Appropriateness Guideline

Prior authorization updates for specialty pharmacy are available

Updates to AIM Radiation Therapy Clinical Appropriateness Guideline

Remaining members will transition to new PBM, IngenioRx, on January 1, 2020

Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline

Reminder about AIM’s new Rehabilitative Program effective November 1, 2019

Appropriate coding helps provide a comprehensive picture of patients’ health

Electronic submission is preferred method for requesting pharmacy prior authorization

Reimbursement Policy Update: Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

Updates to AIM Advanced Imaging of the Abdomen and Pelvis Clinical Appropriateness Guideline

Blue Cross and Blue Shield Association mandate about Medicare Advantage care management and provider engagement

Changes to timely filing requirements for Commercial plans for all claims submitted to plan on or after October 1, 2019

Get the latest critical information from Empire that impacts you; View Provider News for easy access at your fingertips

Medical drug Clinical Criteria updates

Aspire Telehealth Palliative Care program

Lowering health risks with no-cost statins

National Accounts 2020 Pre-certification list

Medicare preferred continuous glucose monitors

Update: 2019 risk adjustment provider training

US Antibiotic Awareness Week is November 11-18, 2019

Empire CRA Reporting Update: Retrospective Program continues

Empire launches additional changes to empireblue.com/provider

Pre-certification information for the Federal Employee Program

UPDATE: New AIM Rehabilitative Program will begin November 1, 2019

Prior authorization requirements changes effective November 1, 2019

Empire specialty pharmacy medical step therapy drug list - clarification

Attention: updated physician lab fee schedules for Medicare Advantage products

Medical Policies and Clinical Utilization Management Guidelines update - June 2019

Medical Policies and Clinical Utilization Management Guidelines update - March 2019

Federal Employee Program® Specialty Pharmacy Clinical Site-of-Care prior authorization review

Empire engages Matrix to conduct mobile health clinics and in-home assessments for targeted members

Changes to PA requirements

Prior authorization changes

Provider satisfaction survey

Coming soon: electronic attachments

PCP after-hours access requirements

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