CommercialDecember 1, 2018
December 2018 Empire Provider Newsletter
Administrative
CommercialNovember 30, 2018
Empire announces a new network - Blue AccessCommercialNovember 30, 2018
Empire announces changes to the Individual Health Benefit PlansCommercialNovember 30, 2018
Prepare NOW for Empire Facility and Physician Portal RetirementCommercialNovember 30, 2018
Availity to serve as EDI entry point for electronic submissionsCommercialNovember 30, 2018
Explore new enhancements to the Education and Reference CenterCommercialNovember 30, 2018
Company works to simplify payment recovery process for National Accounts membershipCommercialNovember 30, 2018
HEDIS® 2018 Commercial Results Are InCommercialNovember 30, 2018
Case Management ProgramCommercialNovember 30, 2018
ConditionCare Program Benefits Patients and PhysiciansCommercialNovember 30, 2018
Integrated Care Model for plans purchased on the Health Insurance Marketplace benefits patients and physiciansCommercialNovember 30, 2018
Coordination of CareCommercialNovember 30, 2018
Important Information about Utilization ManagementCommercialNovember 30, 2018
Members’ Rights and ResponsibilitiesCommercialNovember 30, 2018
Vaginal Birth after Cesarean (VBAC) Certified Shared Decision Making Aid Available on the WebCommercialNovember 30, 2018
Clinical practice and preventive health guidelines available onlinePolicy Updates
CommercialNovember 30, 2018
Policy updatesCommercialNovember 30, 2018
Medical Policy UpdatesCommercialNovember 30, 2018
Clinical Guideline UpdatesCommercialNovember 30, 2018
Review medical policy and clinical guidelines when referring services to a facilityCommercialNovember 30, 2018
Update to AIM Clinical Appropriateness GuidelinesCommercialNovember 30, 2018
Updates to AIM Musculoskeletal Surgery Clinical Appropriateness GuidelinesCommercialNovember 30, 2018
Restructure of AIM Advanced Imaging Clinical Appropriateness GuidelinesCommercialNovember 30, 2018
Reimbursement Policy UpdatesCommercialNovember 30, 2018
Reimbursement for Convenience Surgical Supply Kits - ProfessionalCommercialNovember 30, 2018
Bundled Services and Supplies - ProfessionalCommercialNovember 30, 2018
Reimbursement Policy Update - Scope of License (Professional)Products & Programs
CommercialNovember 30, 2018
Coordination of Benefits for an FEP memberCommercialNovember 30, 2018
Benefit change for Infliximab for Federal Employee ProgramCommercialNovember 30, 2018
2019 FEP Benefit information available onlineCommercialNovember 30, 2018
Empire accepts electronic prior authorization requests for prescription medications onlineCommercialNovember 30, 2018
Introducing the new Clinical Criteria page for injectable, infused or implanted drugsCommercialNovember 30, 2018
Pharmacy information available on empireblue.comState & Federal
Medicare AdvantageNovember 30, 2018
New Medicare Advantage provider service phone number beginning January 1, 2019Medicare AdvantageNovember 30, 2018
2019 Medicare Advantage individual benefits and formulariesMedicare AdvantageNovember 30, 2018
CMS Medicare Preclusion List effective April 1, 2019Medicare AdvantageNovember 30, 2018
When and how to initiate Medicare Advantage reopeningsMedicare AdvantageNovember 30, 2018
Individual Medicare plans move compound drugs off formulary beginning January 1, 2019Medicare AdvantageNovember 30, 2018
Medicare Part B drugs may include Step Therapy beginning January 1, 2019Medicare AdvantageNovember 30, 2018
MediBlue Select HMO Network expands effective January 1, 2019Medicare AdvantageNovember 30, 2018
Medical Policies updatedMedicare AdvantageNovember 30, 2018
Keep up with Medicare newsMedicaidNovember 30, 2018
Electronic data interchange gateway updateMedicaidNovember 30, 2018
Empire HealthPlus adopts MCG Care Guidelines for clinical reviews of mental health servicesMedicaidNovember 30, 2018
Prior authorization requirements for SublocadeMedicaidNovember 30, 2018
Prior authorization requirements for Subcutaneous Implantable Defibrillator systemMedicaidNovember 30, 2018
UPDATE: Prior authorization requirements for high-level, definitive drug testing delayedMedicaidNovember 30, 2018
Viral suppression rates improve in patients with HIV in the US,while disparities continue to existMedicaidNovember 30, 2018
Reimbursement Policy Update: Claims Requiring Additional Documentation (Policy 06-031, effective 03/01/19)MedicaidNovember 30, 2018
Transition of Outpatient Rehabilitation Utilization Management Program effective January 1, 2019MedicaidNovember 30, 2018
Medical Policies and Clinical Utilization Management Guidelines updateMedicaidNovember 30, 2018
Coding spotlight: substance use disorders and smokingMedicaidNovember 30, 2018
Pharmacy management informationMedicaidNovember 30, 2018
Practitioners’ rights during credentialing processTo view this publication online:
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