Policy Updates Prior AuthorizationMedicaidJuly 26, 2023

Prior authorization requirement changes effective September 1, 2023

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Effective September 1, 2023, prior authorization (PA) requirements will change for the following code(s). The medical code(s) listed below will require PA by Empire BlueCross BlueShield HealthPlus for Medicaid members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines (including definitions and specific contract provisions/exclusions) take precedence over these PA rules and must be considered first when determining coverage. Non-compliance with new requirements may result in denied claims.

Prior authorization requirements will be added for the following code(s):

Code

Code description

A0888

Noncovered Ambulance Mileage

E0465

Home ventilator, any type, used with invasive interface, (for example, tracheostomy tube)

E0467

Home ventilator, multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components, and supplies for all functions

E2500

Speech generating device, digitized speech, using pre-recorded messages, 8 min. or less

E2502

Speech generating device, digitized speech, using pre-recorded messages, 8-20 min.

E2506

Speech generating device, digitized speech, using pre-recorded messages, over 40 min.

E2508

Speech generating device, synthesized speech, requiring message formulation by spelling

E2512

Accessory for speech generating device, mounting system

To request PA, you may use one of the following methods:

  • Web: Once logged in to Availity Essentials* at https://availity.com
  • Fax: 800-964-3627
  • Phone: 800-450-8753

Not all PA requirements are listed here. Detailed PA requirements are available to providers at https://mediprovider.empireblue.com/new-york-empire-provider/communications/news-and-announcements on the Resources tab or, for contracted providers, by accessing Availity.com. Providers may also call Provider Services at 800-450-8753 for assistance with PA requirements.

UM AROW #4230

* Availity, LLC is an independent company providing administrative support services on behalf of the health plan.

NYBCBS-CD-023886-23-CPN23495

PUBLICATIONS: September 2023 Provider Newsletter