CommercialDecember 1, 2021
December 2021 Newsletter
Administrative
CommercialNovember 30, 2021
Prepare for the Consolidated Appropriations Act: Keep your provider directory information up to dateCommercialNovember 30, 2021
Facility option to receive verbal UM Notifications electronicallyCommercialNovember 30, 2021
Submitting prior authorizations is getting easierEmpire is transitioning to the Availity Authorization app
CommercialNovember 30, 2021
Is prior authorization required?Answering your questions about the new Availity Authorization app
CommercialNovember 30, 2021
Chlamydia screening for teens and young adultsCommercialNovember 30, 2021
Outpatient system updates for 2022CommercialNovember 30, 2021
Professional system updates for 2022CommercialNovember 30, 2021
Clinical practice and preventive health guidelines available on empireblue.comCommercialNovember 30, 2021
Coordination of careCommercialNovember 30, 2021
Member rights and responsibilitiesCommercialNovember 30, 2021
Important information about utilization managementCommercialNovember 30, 2021
Case management programCommercialNovember 30, 2021
Importance of PCP after-hours messagingCommercialNovember 30, 2021
Behavioral healthcare appointment access requirementsCommercialNovember 30, 2021
Reminder: The 32BJ Health Fund Centers of Excellence for Bariatric and Joint Replacement Surgery program begins January 1, 2022CommercialNovember 30, 2021
Reminder: EnrollSafe is available - electronic funds transfer enrollment portal for Empire providersCommercialNovember 30, 2021
Utilization management tool available on Availity Payer Spaces: Authorization Rules Lookup toolPolicy Updates
CommercialNovember 30, 2021
Updates to AIM Specialty Health Musculoskeletal Interventional Pain Management clinical appropriateness guidelineCommercialNovember 30, 2021
Updates to AIM Specialty Health Cardiology clinical appropriateness guidelinesCommercialNovember 30, 2021
Updates to AIM Specialty Health Radiation Oncology clinical appropriateness guidelineCommercialNovember 30, 2021
Updates to AIM Advanced Imaging clinical appropriateness guidelineCommercialNovember 30, 2021
Reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) - professionalMaterial Adverse Change (MAC)
CommercialNovember 30, 2021
New reimbursement policy update: Modifier 62: Co-Surgeon Services and Modifier 66: Surgical Teams - professionalMaterial Adverse Change (MAC)
CommercialNovember 30, 2021
Reimbursement policy update: Virtual Visits - professional and facilityProducts & Programs
CommercialNovember 30, 2021
Empire to retire Blue Precision program on December 31, 2021CommercialNovember 30, 2021
Clinical Criteria updates for specialty pharmacyCommercialNovember 30, 2021
Pharmacy information available on empireblue.comState & Federal
MedicaidNovember 30, 2021
Reimbursement policy update: Drug Screen Testing (effective March 1, 2022)MedicaidNovember 30, 2021
Reimbursement policy update: Multiple and Bilateral Surgery - Professional and Facility (effective 03/01/22)MedicaidNovember 30, 2021
HEDIS measures: Follow-Up After ED Visits for Mental Illness and Alcohol and Drug DependencyMedicaidNovember 30, 2021
Claims editing update for ICD-10-CM Excludes1 notesMedicaidNovember 30, 2021
Updates to AIM Specialty Health Advanced Imaging clinical appropriateness guidelinesMedicaidNovember 30, 2021
Medical Policies and Clinical Utilization Management Guidelines updateMedicaidNovember 30, 2021
Good news: Non-payment remittance advice enhancements are hereMedicaidNovember 30, 2021
Submitting prior authorizations is getting easierMedicaidNovember 30, 2021
Keep up with Medicaid news - December 2021View these Medicaid articles:
- Durable medical equipment prior authorization requirement changes effective December 1, 2021
- Cancer Care Navigator
- Medical drug benefit Clinical Criteria updates
- Prior authorization updates for medications billed under the medical
benefit - Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines
- Updates to AIM Specialty Health musculoskeletal interventional pain management
clinical appropriateness guideline
Medicare AdvantageNovember 30, 2021
City of New York GRS Alliance Program (Updated 12/3/21)Medicare AdvantageNovember 30, 2021
Webinars for City of New York retirees transitioning to new Medicare Advantage plan (Updated 12/3/21)Medicare AdvantageNovember 30, 2021
Reimbursement Policy Update: Drug Screen Testing (effective March 1, 2022)Medicare AdvantageNovember 30, 2021
Updates to AIM Specialty Health Advanced Imaging clinical appropriateness guidelinesMedicare AdvantageNovember 30, 2021
2022 Medicare Advantage service area and benefit updatesMedicare AdvantageNovember 30, 2021
Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodiesMedicare AdvantageNovember 30, 2021
Good news: Non-payment remittance advice enhancements are hereMedicare AdvantageNovember 30, 2021
Submitting prior authorizations is getting easierMedicare AdvantageNovember 30, 2021
Keep up with Medicare news - December 2021View these Medicare articles:
- Medical drug benefit Clinical Criteria updates
- FAQ: NYC Medicare Advantage Plus
- Protocol for providers serving members with hearing aid
coverage administered by Hearing Care Solutions - Medical Policies and Clinical Utilization Management Guidelines update
- Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines
- Updates to AIM Specialty Health musculoskeletal interventional pain management
clinical appropriateness guideline
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