Update to the Pregnancy Notification Form

Empire BlueCross BlueShield HealthPlus (Empire) is excited to share that we have recently made an update to our Pregnancy Notification Form, which will allow us to gather additional information. This information will provide Empire with important details about a member’s conditions that are not easily garnered from claims alone. The information you provide on the Pregnancy Notification Form, as well as the health information that we are able to leverage via claims and authorizations, will allow Empire to better identify pregnant members with high risk factors so that we can provide timely and comprehensive care management.

 

The Pregnancy Notification Form is available on the Empire BlueCross BlueShield HealthPlus provider website at https://mediprovider.empireblue.com/new-york-empire-provider/home > Resources > Forms under the Pregnancy and Maternal Child Services section for easy access and will replace any existing pregnancy notification form you are currently using.

 

You may also download the form here:

https://mediprovider.empireblue.com/docs/gpp/NYE_CAID_NotificationofPregnancy.pdf?v=202102121634

 

If you have questions, please contact Provider Services at 800-450-8753 or your OB Practice Consultant.

NYBCBS-CD-008836-22