 Provider News New YorkDecember 2023 Provider NewsletterBeginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Effective for claims processed on or after December 1, 2023, the editing systems at Empire BlueCross BlueShield will be updated to align with the American Medical Association (AMA) CPT® Manual, HPCPS Level II Manual, and Centers for Medicare & Medicaid Services (CMS) correct coding guidelines, for the following services: Ulcer debridement and ulcer staging:- According to the ICD-10 Diagnosis Coding Manual, specific diagnosis codes that reflect the stage of the ulcer should be billed with the appropriate CPT code. For example, if billing a stage 3 pressure ulcer code, a stage 4 diagnosis code should not be reported.
- According to the AMA CPT Manual, a debridement of an ulcer should be reported with the appropriate diagnosis code that reflects that service.
Billing of anatomical modifiers:- According to the AMA CPT and HCPCS Level II manuals, the appropriate anatomical modifier is required to be appended to the appropriate procedure code. If not, the claim line will be denied. These modifiers designate the body part that a service is being performed on (for example, FA: Left hand, thumb, TA: Left foot, great toe).
Billing of interprofessional telephone/internet consultations:- These billed procedure codes will follow the AMA CPT Manual coding guidelines.
Claim lines not billed in accordance with the correct coding guidance outlined above will be denied. If you disagree with a claim reimbursement decision, please follow the claim dispute process (including submission of such documentation with the dispute) as outlined in the Provider Manual. If you have questions about this communication or need assistance with any other item, contact your provider relationship management representative. With your help, we can continually build towards a future of shared success. Services provided by Empire HealthChoice HMO, Inc., Empire HealthChoice Assurance, Inc., or Empire BlueCross BlueShield Retiree Solutions. Empire BlueCross BlueShield Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. lndependent licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield plans. NYBCBS-CR-038662-23, NYBCBS-CR-046279-23-CPN45683 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. We ask that you review your online provider directory information on a regular basis to ensure it is accurate. Access your information by visiting empireblue.com/provider, then select the Find Care button at the top right of the webpage. Submit updates and corrections to your directory information by following the instructions on our Provider Maintenance webpage. We will send you an email acknowledging receipt of your request. Online update options include: - Add/change an address location
- Name change
- Phone/fax number change
- Provider leaving a group or a single location
- Closing a practice location
The Consolidated Appropriations Act (CAA) of 2021 contains a provision that requires online provider directory information be reviewed and updated as needed at least every 90 days. Reviewing your information on a regular basis is the best way to help ensure your online provider directory information is current. With your help, we can continually build towards a future of shared success. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-044660-23-CPN44642 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Coordination of care among providers is a vital aspect of good treatment planning to ensure appropriate diagnosis, treatment, and referral. Empire BlueCross BlueShield (Empire) would like to take this opportunity to stress the importance of communicating with your patient’s other healthcare practitioners. This includes primary care physicians (PCPs) and medical specialists, as well as behavioral health practitioners (BH). Coordination of care is especially important for patients with high utilization of general medical services and those referred to a BH specialist by another healthcare practitioner. Empire urges all of its practitioners to obtain the appropriate permission from these patients to coordinate care between BH and other healthcare practitioners at the time treatment begins. We expect all healthcare practitioners to: - Discuss with the patient the importance of communicating with other treating practitioners.
- Obtain a signed release from the patient and file a copy in the medical record:
- Document in the medical record if the patient refuses to sign a release.
- Document in the medical record if you request a consultation.
- If you make a referral, transmit necessary information; and if you are furnishing a referral, report appropriate information back to the referring practitioner.
- Document evidence of clinical feedback (in other words, consultation report) that includes, but is not limited to:
- Diagnosis
- Treatment plan
- Referrals
- Psychopharmacological medication (as applicable)
To facilitate coordination of care, we have several tools available on our Provider website for BH and other medical practitioners including: - Coordination of Care Form
- Coordination of Care Letter Template - Behavioral Health
- Coordination of Care Letter Template - Medical
The following behavioral health forms, brochures, and screening tools for substance use and attention-deficit/hyperactivity disorder (ADHD) are also available on our Provider website: - Alcohol Use Assessment Brochure
- Antidepressant Medication Management
- Edinburgh Postnatal Depression Scale
- Opioid Use Assessment Brochure
- Substance Brief Intervention/Referral Tool (SBIRT)
- Vanderbilt ADHD Diagnostic Parent Rating Scale
Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-044471-23-CPN44372 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Managing any illness can be a difficult thing to do. Knowing who to contact, what test results mean, or how to get needed resources is very important and can be overwhelming. Empire Blue Cross and Blue Shield (Empire) is available to help with our Case Management Program. Our case managers are part of an interdisciplinary team of clinicians and professionals that are there to support members, families, primary care physicians, behavioral health (BH) practitioners, and caregivers. The case management process uses the experience and expertise of the care coordination team whose goal is to educate and empower our members to increase self-management skills, understand their illness, and learn about care choices in order to access quality, efficient healthcare. For physical health services, members or caregivers can refer themselves or family members by calling the number located below. They will be transferred to a team member based on the immediate need. Physicians can also refer their patients by contacting us telephonically or through electronic means. No issue is too big or too small. We can help with transitions across level of care so that patients and caregivers are better prepared and informed about healthcare decisions and goals. For BH or substance use disorder services members can contact their health plan to verify benefits and access Empire.com, or if an FEP member, fepblue.com to search for and access BH providers. It is best to have the member or member’s family contact our department directly to ensure privacy. How do you contact us?For commercial and exchange members, the member can contact customer service for assistance. For FEP members, physical and behavioral health practitioners can refer to Empire behavioral health case management with member consent by calling 800-711-2225 option 3. | Email address (if available) | Phone number | Business hours | NY Local NYC 32 BJ Suffolk County | Dolores.Janes@empireblue.com nycity@empireblue.com Patricia.holt@empireblue.com | 800-563-5909 866-670-1469 833-839-7923 866-962-1325 | Monday to Friday 8 a.m. to 7 p.m. ET Monday to Friday 8 a.m. to 7 p.m. ET Saturday 9 a.m. to 5:30 p.m. ET Monday to Friday 8 a.m. to 5:30 p.m. ET
| National | Care.management@anthem.com | 855-239-0364 Transplant Phone: 866-536-9897 x1664030784 Fax: 888-438-7051 | Monday-Friday, 8 a.m.-9 p.m. ET Saturday 9 a.m.-5:30 p.m. ET Monday-Friday 8:30 a.m.-5 p.m. ET (Transplant) | FEP | FEP.Care.Coordination@anthem.com | 800-711-2225 | Monday-Friday, 9 a.m.-6 p.m. ET |
Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-044869-23-CPN44375 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. The National Committee on Quality Assurance (NCQA) has advised Durable Medical Equipment (DME) providers are to be considered within the scope of an entity’s credentialing program for accreditation purposes. Starting February 2024, recredentialing of the existing Durable Medical Equipment Providers and Prosthetic and Orthotic Suppliers (DMEPOS) network will begin. You will receive communication asking you to either complete an application or to supply us with any of the following information: - Copy of all federal, state, and/or local licenses required to operate as a healthcare facility (by location).
- Copy of accreditation certificate or letters if accredited.
- Copy of most recent CMS or state survey (with deficiencies) including cover letter from CMS or state agency stating facility is in substantial compliance or Corrective Action Plan if deficiencies were cited if not accredited is required.
Please respond to these communications as quickly as possible so no disruption in service to our members or to you occurs. Contact information for questions related to this change will be included in the outreach sent. Through genuine collaboration, we can simplify access to care and help you deliver high-quality, equitable healthcare. The Credentialing team looks forward to working with you. What if I need assistance?If you have questions about this communication or need assistance with any other item, contact your local Provider Relationship Management representative or call Provider Services at 800-450-8753 for Medicaid. For Commercial and Medicare Advantage refer providers to the number on the back of their patient’s member ID card for Provider Services. Medicaid products offered by Empire BlueCross BlueShield HealthPlus, trade name of HealthPlus HP, LLC. Services provided by Empire HealthChoice HMO, Inc., Empire HealthChoice Assurance, Inc., or Empire BlueCross BlueShield Retiree Solutions. Empire BlueCross BlueShield Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. lndependent licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield plans. NYBCBS-CDCRCM-041413-23-CPN39398 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. In 2024, the annual PCP Access Studies Office Level Survey will be performed by a new vendor, the Center for the Study of Services (CSS). The purpose of this survey is to assess adequate appointment wait times for our members with an urgent condition or for routine services. The survey will be conducted in the same manner as in the past, and your cooperation is expected and appreciated. Kindly notify office staff of the requirement to participate in this survey. Keeping your data up to date is a condition of your provider contract with Anthem Blue Cross and Blue Shield (Anthem) and a requirement as part of the Consolidated Appropriations Act (CAA). We ask that you update office information using the PDM application on the Availity Essentials platform and that you participate in quality programs such as this critical survey. Office information crucial for the survey includes: - Having correct, working phone numbers.
- Updating information such as when a practitioner has moved, retired, or is deceased.
- Updating if your practice is no longer contracted with Anthem, accepts private pay only, or is no longer in business.
You are also required to provide compliant after-hours, 24/7, urgent care messaging, instructing the caller/patient to hang up and call 911 or go to urgent care or emergency room (ER) or you must directly connect the caller with PCP or on-call physician. Your contract compels access for all covered members to obtain timely needed appointments. The leading timeframes are below. New York Primary care appointment access | Urgent appointment | Within 24 hours | Routine appointment, with symptoms Non-urgent symptomatic check-up | Within 5 business days | Routine appointment | Within 10 business days | Routine physical appointment | Within 30 days/4 weeks | Routine/follow-up appointment Evaluate progress from today’s visit | Within 14 calendar days | Preventive care appointment | Within 60 calendar days | See your Empire BlueCross BlueShield Provider Manual for details |
Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-044765-23-CPN44728 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. The annual behavioral health access studies will see a change in 2024 as a new vendor, Center for the Study of Services (CSS) in Washington, D.C., will be performing the office level survey and making calls during the first through third quarters. The survey will be conducted in the same manner as in the past and your cooperation is expected and appreciated. The purpose is to assess adequate appointment wait times for our members with an urgent condition or for routine services. Consequently, we ask that you update office information using the PDM application on Availity Essentials or follow processes if assigned to Carelon Behavioral Health, Inc., and that you participate in quality programs, such as this critical survey, as a condition of your contract. The main challenges the vendor encounters are incorrect or non-working phone numbers; practitioner moved, retired, or is deceased; the practice has left their Empire BlueCross BlueShield (Empire) contract, accepts private pay only, or is no longer in practice; and staff refusing to participate in the survey. Please take time to update information for each practitioner associated with the practice phone number(s), past or present. Your contract compels access for all covered individuals to obtain timely needed appointments. The leading timeframes are below. See your Empire Provider Manual for details. And don’t forget your compliant after-hours emergency or urgent messaging 24/7, by a recording or a live person, instructing the caller/patient to hang up and call 911 or 24-hour crisis services, or go to urgent care or ER; or directly connecting with practitioner or on-call practitioner. New York behavioral healthcare appointment accessEmergent — non-life threatening | Within six hours | Urgent appointment | Within 24 hours | Discharge follow-up BH appointment (new or existing patient — inpatient psychiatric hospital release) | Within seven calendar days | Routine — initial appointment (new patient) | Within 10 business days | Routine — regular appointment | Within 10 business days | Routine — follow-up appointment (evaluate progress from today’s visit) | Within 30 calendar days |
We are committed to helping patients more easily access the care they need. Carelon Behavioral Health, Inc. is an independent company providing utilization management services on behalf of the health plan. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-044750-23-CPN44731 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. As a reminder, we will update our claim editing software for outpatient facility services throughout 2024, with many updates occurring quarterly. These updates include, but are not limited to: - The addition of new and revised codes (for example, CPT®, HCPCS, ICD-10, modifiers, revenue codes) and associated edits.
- Updates related to the appropriate use of various code combinations, including but not limited to, CPT/HCPCS code to revenue code, type of bill to procedure code, type of bill to CPT/HCPCS code, and CPT/HCPCS code to modifier.
- Updates to National Correct Coding Initiative edits (NCCI) and facility outpatient hospital services medically unlikely edits (MUEs).
- Updates to reflect coding requirements as designated by industry standard sources such as the National Uniform Billing Committee (NUBC) and the Centers for Medicare and Medicaid Services (CMS).
Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-044219-23-CPN44078 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. As a reminder, we will update our claim editing software for professional services throughout 2024, with most updates occurring quarterly. These updates apply to any provider, provider group (identified by tax identification number), and/or across providers and claim type (such as, professional or facility) and include, but are not limited to: - The addition of new, and revised codes (for example, CPT®, HCPCS, ICD-10, modifiers) and associated edits such as:
- ICD-10 laterality
- Add-on procedures (indicated by + sign)
- Code book parenthetical statements and other directives about appropriate code use (for example, separate procedure, do not report, list separately in addition to, etc.)
- Updates to editing for multiple procedure and bilateral reduction calculations based on relative value unit (RVU) as designated and updated by the Centers for Medicare & Medicaid (CMS) in the physician fee schedule relative value (PFSRV) files
- Updates to National Correct Coding Initiative edits (NCCI) and medically unlikely edits (MUEs)
- Updates to incidental, mutually exclusive, and unbundled (re-bundle) edits
- Updates to code edits associated with reimbursement policies including, but not limited to, bundled services, global surgery preoperative, and post-operative periods assigned by CMS, edits that allow/disallow for assistant surgeon/co-surgeon/team surgeon, and frequency edits.
Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-044215-23-CPN44074 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Our utilization management (UM) decisions are based on the appropriateness of care and service needed, as well as the member’s coverage according to their health plan. We do not reward providers or other individuals for issuing denials of coverage, service, or care. Nor, do we make decisions about hiring, promoting, or terminating these individuals based on the idea or thought that they will deny benefits. In addition, we do not offer financial incentives for UM decision makers to encourage decisions resulting in under-utilization. The Empire BlueCross BlueShield (Empire) Medical Policies are available on Empire’s website at empireblue.com/provider. You can also request a free copy of our UM criteria from our medical management department, and each Treating and Ordering Provider directly involved in the member’s care may discuss a UM denial decision with a physician reviewer by calling us at the toll-free number listed on the UM denial letter, if they haven’t already done so, and before all applicable appeals are completed. UM criteria are also available on the web. Just go to empireblue.com/provider > See Policies, Guidelines, and Manuals > View Medical Policies and Clinical UM Guidelines. We work with providers to answer questions about the utilization management process and the authorization of care. Here’s how the process works: - Call us toll free from 8:30 a.m. to 5 p.m. Monday through Friday (except on holidays). More hours may be available in your area. Federal Employee Program hours are 8 a.m. to 7 p.m. Eastern.
- Our associates will contact you about your UM inquiries during business hours, unless otherwise agreed upon.
The following phone lines are for physicians and their staffs. Members should call the customer service number on their health plan ID card. 
For language assistance, members can simply call the Customer Service phone number on the back of their ID card and a representative will be able to assist them. Our utilization management associates identify themselves to all callers by first name, title, and our company name when making or returning calls. They can inform you about specific utilization management requirements, operational review procedures, and discuss utilization management decisions with you. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-044489-23-CPN44381 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. On January 1, 2024, Empire will become Anthem. Please review the key dates below for changes you will see beginning in December: Date | Change | December 9, 2023 | Empire BCBS-Anthem BCBS will be a tile in Availity Essentials under Payer Spaces. The payer ID is not changing. You may perform all activities in Availity Essentials from December 9, 2023, and beyond under the new name. | January 1, 2024 | The new Anthem provider website launches at https://providers.anthem.com/ny Our website will have a similar look as our current Anthem website with the same navigation. We will also be redirecting Empire URLs to our new website. | January 1, 2024 | We begin operating under the new Anthem name: - Begin using the new Provider Services number:
800-450-8753 Monday through Friday, 8 a.m. to 6 p.m. ET. - Begin using the new Member Services number:
800-300-8181 (TTY 711) Monday through Friday, 8 a.m. to 6 p.m. ET. - Members will begin presenting in your office with an Anthem ID card; however, you can accept the Empire card as well.
|
|
|
Remember to update any internal systems to Anthem, along with your practice’s website (if you list us by name). Please share this information with front office and billing staff. You can also view the following resource for more detail: Availity, LLC is an independent company providing administrative support services on behalf of the health plan. Medicaid products offered by Empire BlueCross BlueShield HealthPlus, trade name of HealthPlus HP, LLC. Services provided by Empire HealthChoice HMO, Inc., Empire HealthChoice Assurance, Inc., or Empire BlueCross BlueShield Retiree Solutions. Empire BlueCross BlueShield Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. lndependent licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield plans. NYBCBS-CDCRCM-038569-23-CPN38553 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. The delivery of quality healthcare requires cooperation between patients, their providers, and their healthcare benefit plans. One of the first steps is for patients and providers to understand their rights and responsibilities. Therefore, in line with our commitment to involve the health plan, participating practitioners, and members in our system, Empire BlueCross BlueShield has adopted a Members’ Rights and Responsibilities statement. This statement can be found on our website under the FAQ question about Laws and Rights that Protect You. To access the statement, visit EmpireBlue Cross BlueShield and select Provider. From there, select Policies, Guidelines & Manuals under Provider Resources. Select your state and scroll down to Member Rights and Responsibilities under More Resources. Then select the Read about member rights link. For federal employees, practitioners may access the FEP member portal at www.fepblue.org/memberrights to view the FEPDO Member Rights Statement. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-044466-23-CPN44377 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. As part of our commitment to provide you with the latest clinical information and educational materials, we have adopted nationally recognized medical, behavioral health and preventive health guidelines, which are available to providers on our website. The guidelines, which are used for our quality programs, are based on reasonable medical evidence, and are reviewed for content accuracy, current primary sources, the newest technological advances, and recent medical research. All guidelines are reviewed annually and updated as needed. The current guidelines are available on our website at https://www.empireblue.com/provider/ and select Medical Policies & UM Guidelines under the Resources tab. If you have questions, please contact the number on the back of the member ID card for Provider Services. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-044453-23-CPN44378 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. A new way to review Medical Policies and Utilization Management (UM) Guidelines for needed documentationUsing Medical Policies and UM Guidelines, we’ve developed a tool that supplies you with a list of recommended documents when submitting prior authorizations or claims. The new Clinical Documentation Lookup Tool uses the CPT® and HCPCS codes you enter to return real-time results. Accessing the tool is easy, too — either by visiting our provider website (access the Clinical Documentation Lookup Tool from our Policies, Guidelines & Manuals section) or through Payer Spaces on Availity.com. For direct access, use this address (available mid-December) https://clinicaldocumentationtool.anthem.com/cdltui/home. Start by entering in the member’s plan type, state, and service dates. Enter the Procedure Code or use the Keyword Search box. The recommended documents will be returned along with a full copy of the Medical Policy. The Clinical Documentation Lookup Tool was developed to be intuitive and easy to use, but we’ve created a demonstration that points out some helpful tips. Access the demo from the top right navigation bar on the Clinical Documentation Lookup Tool. The new Clinical Documentation Lookup Tool will be available in December. Try it and tell us what you think by completing the Was this tool helpful? question. We are focused on reducing administrative burdens, so you can do what you do best — care for our members. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-045314-23-CPN44857 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Making the Claims Process Work for You — a short on-demand video and step-by-step guideTimely and accurate submission of claims plays a crucial role in a healthcare provider’s revenue management, operational efficiency, and patient satisfaction. As your trusted partner in health, we are committed to providing you and your staff with the resources you need to help make delivering quality care easier. Watch this short on-demand video and step-by-step guide to help you submit a claim correctly the first time, reduce duplicate claims and common submission errors, and properly submit corrected claims resulting in faster payments, less rework, and happier patients. Watch the quick training video and download the guide and learn how to: - Get it right the first time and proactively reduce denied and duplicate claims.
- Properly submit a corrected claim through Availity Essentials using the correct frequency code.
- Properly submit claims using electronic data interchange (EDI), including useful tips for your clearinghouses and vendors.
- Understand role requirements.
Start improving claims processing for your practice: Access your on-demand video and step-by-step guide now. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-045308-23-CPN44893, NYBCBS-CM-047949-23-CPN47295 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. When you have more information to share about a claim that has been denied, filing the dispute digitally is a cost-effective and time-saving alternative to paper and fax. You can feel confident that we have received your claims dispute when you submit it through the digital workflow. This Claim Status application feature, available on Availity.com, enables a fast, efficient, and streamlined process for filing claim disputes: - Upload supporting documentation and attach it directly to the claim.
- Use the Appeals Dashboard:
- To review digitally filed disputes.
- To retrieve correspondence related to your disputes.
- For a history of digitally filed disputes.
How to file a digital claim payment dispute:- Log onto Availity.com.
- Select the Claims & Payments tab.
- Select Claim Status and enter the information needed to retrieve your claim.
- When you have found your claim, select the Dispute button to initiate a dispute (it will be visible when your claim is eligible for a dispute).
- Access your Appeals Dashboard to upload the supporting documents, locate initiated dispute, and complete the dispute request:
- From the Claims & Payments tab select Appeals to access your Appeals Dashboard.
In the past, you may have used the Attachment button and selected the Dispute option to dispute a claim. We’ve eliminated that process to make disputing a claim more trackable and transparent. 
Receive dispute determinations digitally from your Appeals DashboardWe will review the dispute and communicate an outcome on Availity.com. Check the status of a digitally submitted dispute at any time from your Appeals Dashboard. Learn moreSubmitting a digital claim payment dispute is easy, but attending informative learning sessions provides a deep dive into the application and its search and filter functions. These tips are sure to make the submission process even easier. Use this link to access on-demand training. For more information about the claim payment dispute process, consult the provider manual or reach out to your provider relationship management representative. NYBCBS-CD-041333-23-CPN41106 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. As a contracted provider for special needs plan (SNP) from Anthem Blue Cross (Anthem), you are required to participate in an annual model of care training for providers per CMS regulations. This training includes a detailed overview of Anthem special needs plans and program information — highlighting cost sharing, data sharing, participation in the Interdisciplinary Care team (ICT), where to access the member’s health risk assessment results, plan of care, and benefit coordination. Please remember this training is specific to our plans and delivery of care for members ensuring their specific care needs are met. Your participation is critical for improved quality and health outcomes. Training for SNP product for Anthem is self-paced and available at availity.com. The training must be completed by December 31, 2023. How to access the Custom Learning Center on the Availity Essentials website:- Log in to Availity Essentials website at availity.com:
- At the top of Availity Essentials website, select Payer Spaces and select the appropriate payer.
- On the Payer Spaces landing page, select Access Your Custom Learning Center from Applications.
- In the Custom Learning Center, select Required Training.
- Select Special Needs Plan and Model of Care Overview.
- Select Enroll.
- Select Start.
- Once the course is completed, select Begin Attestation and complete.
Not registered for Availity Essentials?Have your organization’s designated administrator register your organization for the Availity Essentials website: - Visit availity.com to register.
- Select Register.
- Select your organization type.
- In the Registration wizard, follow the prompts to complete the registration for your organization.
Refer to these PDF documents: https://apps.availity.com/availity/Demos/Registration/index.htm for complete registration instructions. Services provided by Empire HealthChoice HMO, Inc., Empire HealthChoice Assurance, Inc., or Empire BlueCross BlueShield Retiree Solutions. Empire BlueCross BlueShield Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. lndependent licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield plans. NYBCBS-CR-044328-23-CPN44315 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. These updates list the new and/or revised Medical Policies and Clinical Guidelines for Empire BlueCross BlueShield (Empire). The implementation date for each policy or guideline is noted for each section. Implementation of the new or revised Medical Policy or Clinical Guideline is effective for all claims processed on and after the specified implementation date, regardless of date of service. Previously processed claims will not be reprocessed as a result of the changes. If there is any inconsistency or conflict between the brief description provided below and the actual policy or guideline, the policy or guideline will govern. Federal and state law, as well as contract language, including definitions and specific contract provisions/exclusions, take precedence over Medical Policy and Clinical Guidelines (and Medical Policy takes precedence over Clinical Guidelines) and must be considered first in determining eligibility for coverage. The member’s contract benefits in effect on the date that the service is rendered must be used. This document supplements any previous Medical Policy and Clinical Guideline updates that may have been issued by Empire. Please include this update with your provider manual for future reference. Please note that Medical Policy, which addresses medical efficacy, should be considered before utilizing medical opinion in adjudication. To view Medical Policies and Clinical Guidelines for Empire, go to empireblue.com > select Providers > under Provider Resources > select Policies, Guidelines & Manuals. Note: These updates may not apply to all administrative services only accounts as some accounts may have nonstandard benefits that apply. To view Medical Policies and Clinical Utilization Management (UM) Guidelines applicable to members enrolled in the Blue Cross and Blue Shield Service Benefit Plan (commonly referred to as the Federal Employee Program [FEP®]), visit fepblue.org > Policies & Guidelines. Clinical Guideline updates Adopted Clinical Guideline effective March 16, 2024 The following guideline will be applied and might result in services that were previously covered but may now be found to be not medically necessary: - CG-MED-95 Transanal Irrigation
Revised Clinical Guideline effective March 16, 2024 The following adopted guideline was revised and might result in services that were previously covered but may now be found to be not medically necessary: - CG-OR-PR-08 Microprocessor Controlled Lower Limb Prosthesis
With your help, we can continually build towards a future of shared success. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-044430-23 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. The Medical Policies, Clinical Utilization Management (UM) Guidelines, and Third-Party Criteria below were developed and/or revised to support clinical coding edits. Note, several policies and guidelines were revised to provide clarification only and are not included. Existing precertification requirements have not changed. Please share this notice with other providers in your practice and office staff. To view a guideline, visit Provider Medical Policy Search Results | EmpireBlue.com. Notes/updatesUpdates marked with an asterisk (*) notate that the criteria may be perceived as more restrictive. - MED.00004 – Noninvasive Imaging Technologies for the Evaluation of Skin Lesions; Previously Titled: Technologies for the Evaluation of Skin Lesions (including Dermatoscopy, Epiluminescence Microscopy, Videomicroscopy and Ultrasonography):
- Revised title
- Added additional technologies to Investigational & Not Medically Necessary section.
- SURG.00161 – Nanoparticle-Mediated Thermal Ablation:
- Nanoparticle-mediated thermal ablation is considered Investigational & Not Medically Necessary for all indications
- CG-ANC-06 – Ambulance Services: Ground; Non-Emergent:
- Revised Medically Necessary and Not Medically Necessary statements regarding mileage.
- Revised Not Medically Necessary statement to remove list of non-covered indications.
- CG-LAB-29 – Gamma Glutamyl Transferase Testing:
- Outlines the Medically Necessary and Not Medically Necessary criteria for laboratory testing of gamma glutamyl transferase (GGT) in blood.
- CG-LAB-30 – Outpatient Laboratory-based Blood Glucose Testing:
- Outlines the Medically Necessary and Not Medically Necessary criteria for laboratory testing to determine blood glucose concentration.
- CG-SURG-95 – Sacral Nerve Stimulation and Percutaneous or Implantable Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention; Previously Titled: Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence, Urinary Retention:
- Revised title
- Added Medically Necessary criteria for temporary SNS for urinary and fecal conditions.
- Reformatted Medically Necessary criteria for permanent SNS for urinary and fecal conditions.
- Revised the Clinical Indications section IV for percutaneous or implantable tibial nerve stimulation (PTNS) to include implantable devices.
Medical Policies On May 11, 2023, the Medical Policy and Technology Assessment Committee (MPTAC) approved the following Medical Policies applicable to Empire BlueCross BlueShield (Empire). These medical policies take effect December 27, 2023. Publish date | Medical Policy number | Medical Policy title | New or revised | 5/25/2023 | GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | Revised | 6/28/2023 | *MED.00004 | Noninvasive Imaging Technologies for the Evaluation of Skin Lesions Previously Titled: Technologies for the Evaluation of Skin Lesions (including Dermatoscopy, Epiluminescence Microscopy, Videomicroscopy and Ultrasonography) | Revised | 7/18/2023 | MED.00135 | Gene Therapy for Hemophilia | Revised | 5/25/2023 | SURG.00121 | Transcatheter Heart Valve Procedures | Revised | 6/28/2023 | *SURG.00161 | Nanoparticle-Mediated Thermal Ablation | New | 6/28/2023 | TRANS.00025 | Laboratory Testing as an Aid in the Diagnosis of Heart Transplant Rejection | Revised |
Clinical UM Guidelines On May 11, 2023, the MPTAC approved the following Clinical UM Guidelines applicable to Empire. These guidelines were adopted by the medical operations committee for Medicare members on June 22, 2023. These guidelines take effect December 27, 2023. Publish date | Clinical UM Guideline number | Clinical UM Guideline title | New or revised | 6/28/2023 | *CG-ANC-06 | Ambulance Services: Ground; Non-Emergent | Revised | 6/28/2023 | CG-DME-31 | Powered Wheeled Mobility Devices | Revised | 6/28/2023 | CG-DME-36 | Pediatric Gait Trainers | Revised | 6/28/2023 | CG-DME-42 | Continuous Glucose Monitoring Devices and External Insulin Infusion Pumps | Revised | 6/28/2023 | CG-GENE-16 | BRCA Genetic Testing | Revised | 6/28/2023 | CG-GENE-22 | Gene Expression Profiling for Managing Breast Cancer Treatment | Revised | 5/25/2023 | CG-LAB-22 | Nucleic Acid Amplification Tests Using Algorithmic Analysis for the Diagnosis of Vaginitis Previously Titled: Nucleic Acid Amplification Tests Using Algorithmic Analysis for the Diagnosis of Bacterial Vaginosis | Revised | 6/28/2023 | CG-LAB-25 | Outpatient Glycated Hemoglobin and Protein Testing | Revised | 6/28/2023 | *CG-LAB-29 | Gamma Glutamyl Transferase Testing | New | 6/28/2023 | *CG-LAB-30 | Outpatient Laboratory-based Blood Glucose Testing | New | 6/28/2023 | CG-MED-59 | Upper Gastrointestinal Endoscopy in Adults | Revised | 6/28/2023 | CG-MED-66 | Cryopreservation of Oocytes or Ovarian Tissue | Revised | 6/28/2023 | CG-SURG-101 | Ablative Techniques as a Treatment for Barrett's Esophagus | Revised | 5/25/2023 | CG-SURG-115 | Mechanical Embolectomy for Treatment of Stroke | Revised | 6/28/2023 | CG-SURG-61 | Cryosurgical, Radiofrequency or Laser Ablation to Treat Solid Tumors Outside the Liver | Revised | 6/28/2023 | CG-SURG-78 | Locoregional Techniques for Treating Primary and Metastatic Liver Malignancies Previously Titled: Locoregional and Surgical Techniques for Treating Primary and Metastatic Liver Malignancies | Revised | 6/22/2023 | CG-SURG-81 | Cochlear Implants and Auditory Brainstem Implants | Revised | 6/28/2023 | *CG-SURG-95 | Sacral Nerve Stimulation and Percutaneous or Implantable Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention Previously Titled: Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence, Urinary Retention | Revised |
Services provided by Empire HealthChoice HMO, Inc., Empire HealthChoice Assurance, Inc., or Empire BlueCross BlueShield Retiree Solutions. Empire BlueCross BlueShield Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. lndependent licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield plans. NYBCBS-CR-043589-23-CPN42042 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. The Medical Policies, Clinical Utilization Management (UM) Guidelines, and Third-Party Criteria below were developed and/or revised to support clinical coding edits. Note, several policies and guidelines were revised to provide clarification only and are not included. Existing precertification requirements have not changed. Please share this notice with other providers in your practice and office staff. To view a guideline, visit empireblue.com/provider/policies/clinical-guidelines/search Notes/Updates:Updates marked with an asterisk (*) notate that the criteria may be perceived as more restrictive. - MED.00004 – Noninvasive Imaging Technologies for the Evaluation of Skin Lesions; Previously Titled: Technologies for the Evaluation of Skin Lesions (including Dermatoscopy, Epiluminescence Microscopy, Videomicroscopy and Ultrasonography)
- Revised title
- Added additional technologies to Investigational & Not Medically Necessary section
- SURG.00161 – Nanoparticle-Mediated Thermal Ablation
- Nanoparticle-mediated thermal ablation is considered Investigational & Not Medically Necessary for all indications
- CG-ANC-06 – Ambulance Services: Ground; Non-Emergent
- Revised Medically Necessary and Not Medically Necessary statements regarding mileage
- Revised Not Medically Necessary statement to remove list of non-covered indications
- CG-LAB-29 – Gamma Glutamyl Transferase Testing
- Outlines the Medically Necessary and Not Medically Necessary criteria for laboratory testing of gamma glutamyl transferase (GGT) in blood
- CG-LAB-30 – Outpatient Laboratory-based Blood Glucose Testing
- Outlines the Medically Necessary and Not Medically Necessary criteria for laboratory testing to determine blood glucose concentration
- CG-SURG-95 – Sacral Nerve Stimulation and Percutaneous or Implantable Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention; Previously Titled: Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence, Urinary Retention
- Revised title
- Added Medically Necessary criteria for temporary SNS for urinary and fecal conditions
- Reformatted Medically Necessary criteria for permanent SNS for urinary and fecal conditions
- Revised the Clinical Indications section IV for percutaneous or implantable tibial nerve stimulation (PTNS) to include implantable devices
Medical PoliciesOn May 11, 2023, the Medical Policy and Technology Assessment Committee (MPTAC) approved the following Medical Policies applicable to Empire BlueCross BlueShield HealthPlus (Empire). These medical policies take effect January 1, 2024. Publish Date | Medical Policy Number | Medical Policy Title | New or Revised | 5/25/2023 | GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | Revised | 6/28/2023 | *MED.00004 | Noninvasive Imaging Technologies for the Evaluation of Skin Lesions Previously Titled: Technologies for the Evaluation of Skin Lesions (including Dermatoscopy, Epiluminescence Microscopy, Videomicroscopy and Ultrasonography) | Revised | 7/18/2023 | MED.00135 | Gene Therapy for Hemophilia | Revised | 5/25/2023 | SURG.00121 | Transcatheter Heart Valve Procedures | Revised | 6/28/2023 | *SURG.00161 | Nanoparticle-Mediated Thermal Ablation | New | 6/28/2023 | TRANS.00025 | Laboratory Testing as an Aid in the Diagnosis of Heart Transplant Rejection | Revised |
Clinical UM GuidelinesOn May 11, 2023, the MPTAC approved the following Clinical UM Guidelines applicable to Empire. These guidelines were adopted by the medical operations committee for Medicaid members on June 22, 2023. These guidelines take effect January 1, 2024. Publish Date | Clinical UM Guideline Number | Clinical UM Guideline Title | New or Revised | 6/28/2023 | *CG-ANC-06 | Ambulance Services: Ground; Non-Emergent | Revised | 6/28/2023 | CG-DME-31 | Powered Wheeled Mobility Devices | Revised | 6/28/2023 | CG-DME-36 | Pediatric Gait Trainers | Revised | 6/28/2023 | CG-DME-42 | Continuous Glucose Monitoring Devices and External Insulin Infusion Pumps | Revised | 6/28/2023 | CG-GENE-16 | BRCA Genetic Testing | Revised | 6/28/2023 | CG-GENE-22 | Gene Expression Profiling for Managing Breast Cancer Treatment | Revised | 5/25/2023 | CG-LAB-22 | Nucleic Acid Amplification Tests Using Algorithmic Analysis for the Diagnosis of Vaginitis Previously Titled: Nucleic Acid Amplification Tests Using Algorithmic Analysis for the Diagnosis of Bacterial Vaginosis | Revised | 6/28/2023 | CG-LAB-25 | Outpatient Glycated Hemoglobin and Protein Testing | Revised | 6/28/2023 | *CG-LAB-29 | Gamma Glutamyl Transferase Testing | New | 6/28/2023 | *CG-LAB-30 | Outpatient Laboratory-based Blood Glucose Testing | New | 6/28/2023 | CG-MED-59 | Upper Gastrointestinal Endoscopy in Adults | Revised | 6/28/2023 | CG-MED-66 | Cryopreservation of Oocytes or Ovarian Tissue | Revised | 6/28/2023 | CG-SURG-101 | Ablative Techniques as a Treatment for Barrett's Esophagus | Revised | 5/25/2023 | CG-SURG-115 | Mechanical Embolectomy for Treatment of Stroke | Revised | 6/28/2023 | CG-SURG-61 | Cryosurgical, Radiofrequency or Laser Ablation to Treat Solid Tumors Outside the Liver | Revised | 6/28/2023 | CG-SURG-78 | Locoregional Techniques for Treating Primary and Metastatic Liver Malignancies Previously Titled: Locoregional and Surgical Techniques for Treating Primary and Metastatic Liver Malignancies | Revised | 6/22/2023 | CG-SURG-81 | Cochlear Implants and Auditory Brainstem Implants | Revised | 6/28/2023 | *CG-SURG-95 | Sacral Nerve Stimulation and Percutaneous or Implantable Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention Previously Titled: Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence, Urinary Retention | Revised |
Empire BlueCross BlueShield HealthPlus is the trade name of HealthPlus HP, LLC, an independent licensee of the Blue Cross Blue Shield Association. NYBCBS-CD-044163-23-CPN43701 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Effective February 20, 2024, Empire BlueCross BlueShield HealthPlus (Empire) will transition to the InterQual® 2023 criteria, to include updates from October 2023. InterQual criteria used by this market: - Adult & Geriatric Psychiatry Criteria
- Child & Adolescent Psychiatry Criteria
If you have any questions, please contact Provider Services at 800-450-8753. Empire BlueCross BlueShield HealthPlus is the trade name of HealthPlus HP, LLC, an independent licensee of the Blue Cross Blue Shield Association. NYBCBS-CD-041309-23-CPN40829 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Effective for dates of service on and after November 5, 2023, the following updates will apply to the Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines for medical necessity review for Empire BlueCross BlueShield HealthPlus: - Musculoskeletal Guidelines:
Existing precertification requirements have not changed. Please share this notice with other members of your practice and office staff. If you have questions about this communication or need assistance with any other item, contact your assigned provider relationship management representative or call Provider Services at 800-450-8753. With your help, we can continually build towards a future of shared success. Empire BlueCross BlueShield HealthPlus is the trade name of HealthPlus HP, LLC, an independent licensee of the Blue Cross Blue Shield Association. NYBCBS-CD-037850-23-CPN37060 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Effective April 1, 2024, Empire will transition to the following genetic testing guidelines for Carelon Medical Benefits Management, Inc. to perform medical necessity/clinical appropriateness reviews for requested genetic tests. Applicable CPT® codes lists are included in each guideline linked below: Prior authorization requirements remain the same. The requested services received on or after April 1, 2024, will be reviewed with the new Clinical Criteria. As a reminder, ordering and servicing providers may submit prior authorization requests directly to the ProviderPortalSM for Carelon Medical Benefits Management directly at providerportal.com. Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization. For questions related to guidelines, please contact Carelon Medical Benefits Management via email at MedicalBenefitsManagement.guidelines@Carelon.com. Additionally, you may access and download a copy of the current and upcoming guidelines here. Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan. Medicaid products offered by Empire BlueCross BlueShield HealthPlus, trade name of HealthPlus HP, LLC. Services provided by Empire HealthChoice HMO, Inc., Empire HealthChoice Assurance, Inc., or Empire BlueCross BlueShield Retiree Solutions. Empire BlueCross BlueShield Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. lndependent licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield plans. NYBCBS-CDCR-041221-23-CPN40797 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Effective April 1, 2024, Empire BlueCross BlueShield will transition to the following Carelon Medical Benefits Management, Inc.* Genetic Testing guidelines to perform medical necessity/clinical appropriateness reviews for requested genetic tests. Applicable CPT® codes lists are included in each guideline linked below: Prior authorization requirements remain the same. The requested services received on or after
March 30, 2024, will be reviewed with the new Clinical Criteria. As a reminder, ordering and servicing providers may submit prior authorization requests to Carelon Medical Benefits Management using the following: - Carelon Medical Benefits Management ProviderPortalSM directly at providerportal.com. Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization.
If you have questions related to guidelines, please contact Carelon Medical Benefits Management via email at MedicalBenefitsManagement.guidelines@Carelon.com. Additionally, you may access and download a copy of the current and upcoming guidelines here. *Carelon Medical Benefits Management, Inc. is an independent company providing administrative support services on behalf of the health plan. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-038768-23-CPN38533 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. In the September 2023 edition of the Provider News, we announced the expansion of the Carelon Medical Benefits Management Musculoskeletal (MSK) Program. We want to inform you that there has been a change in the program implementation timeline. As previously announced, the medical necessity/clinical appropriateness reviews for the requested site of service for certain spine, joint, and interventional pain procedures will be implemented on December 29, 2023. However, the implementation date for reviews for monitored anesthesia or conscious sedation (MAC), when requested in conjunction with interventional pain codes has been delayed. A new program date has not yet been determined. An update will be provided at least 30 days prior to the start of this program. As a reminder, the Musculoskeletal Program applies to fully insured members of Empire BlueCross BlueShield (Empire) as outlined below. Please note, these reviews do not apply to procedures performed on an emergent basis. Carelon Medical Benefits Management will use the following Clinical Appropriateness Guidelines when performing these reviews. The Clinical Criteria to be used can be found by accessing the links below. Site of care reviewsCarelon Medical Benefits Management will continue to manage the Musculoskeletal Program and level of care review. The Level of Care Guideline for Musculoskeletal Surgery and Procedures is used for the level of care review. A subset of the Carelon Medical Benefits Management Musculoskeletal Program codes will be reviewed for site of care. A complete list of CPT® codes requiring prior authorization for the Musculoskeletal Site of Care program is available on the Carelon Medical Benefits Management Musculoskeletal microsite. Members included in the programAll fully insured members currently participating in the Carelon Medical Benefits Management Musculoskeletal Program are included. This program will be offered to self-funded (ASO) groups that currently participate in the Musculoskeletal Program to add to their members’ benefit package as of December 29, 2023. To determine if prior authorization for the Carelon Medical Benefits Management Musculoskeletal Program applies to an Empire member, contact the Provider Services phone number on the back of the member’s ID card. The following members are excluded: Medicare Advantage (individual and group), Medicaid, Medicare, Medicare supplement, and the Federal Employee Program® (FEP®). Prior authorization requirementsFor services scheduled to begin on or after December 29, 2023, care providers must contact Carelon Medical Benefits Management to obtain prior authorization. Ordering and servicing care providers may begin contacting Carelon Medical Benefits Management on December 18, 2023. Care providers may submit prior authorization requests to Carelon Medical Benefits Management in one of several ways: - Access ProviderPortal directly at providerportal.com. Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization. Initiating a request on ProviderPortal and entering all the requested clinical questions will allow you to receive an immediate determination.
- Access Carelon Medical Benefits Management via the Availity Essentials platform at Availity.com.
- Call the Carelon Medical Benefits Management Contact Center toll-free number at 866-714-1107, Monday through Friday, 8 a.m. to 5 p.m.
- The Musculoskeletal Program microsite helps you learn more and access helpful information and tools such as order entry checklists.
Note: If a care provider office attempts to use the Interactive Care Reviewer (ICR) tool on the Availity Essentials platform to prior authorize an outpatient musculoskeletal case, ICR will produce a message referring the care provider to Carelon Medical Benefits Management. (ICR cannot accept prior authorization requests for services administered by Carelon Medical Benefits Management.) Musculoskeletal Site of Care training webinarsWe invite you to take advantage of a free informational webinar that will introduce the program and the robust capabilities of the Carelon Medical Benefits Management ProviderPortal. Use the links below to register for an upcoming webinar. If you have previously registered for other services managed by Carelon Medical Benefits Management, there is no need to register again. We value your participation in our network and look forward to working with you to improve the health of our members. Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-043898-23 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. The following services will be added to precertification for the effective dates listed below. To obtain precertification, providers can access Availity at Availity.com or call Empire BlueCross BlueShield’s Utilization Management department using the number on the back of the member’s ID card. Service preapproval is based on member’s benefit plan/eligibility at the time the service is reviewed/approved. Precertification can help avoid unnecessary charges or penalties by helping to ensure that the member’s care is medically necessary and administered at an appropriate network facility and by a network provider. Add to precertification | Criteria | Criteria description | Code | Effective date | DME.00022 | Functional Electrical Stimulation (FES); Threshold Electrical Stimulation (TES) | E0770 | March 1, 2024 |
Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-044967-23 Prior authorization updates for medications billed under the medical benefit Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Effective on December 1, 2023, the following medication codes billed on medical claims from current or new Clinical Criteria documents will require prior authorization. Inclusion of a national drug code on your medical claim is necessary for claims processing. Visit the Clinical Criteria website to search for the specific Clinical Criteria listed below. Clinical Criteria | HCPCS or CPT® code(s) | Drug name | CC-0062 | J3490, Q5131 | Idacio (adalimumab-aacf) |
What if I need assistance?If you have questions about this communication or need assistance with any other item, contact your local provider relationship management representative or call Provider Services at 800-450-8753. Note: Prior authorization requests for certain medications may require additional documentation to determine medical necessity. Empire BlueCross BlueShield HealthPlus is the trade name of HealthPlus HP, LLC, an independent licensee of the Blue Cross Blue Shield Association. NYBCBS-CD-040834-23-CPN40471 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. UPDATE: This article was originally published as being effective March 1, 2024. The effective date has been delayed to May 1, 2024. Effective May 1, 2024, prior authorization (PA) requirements will change for the following code(s). The medical code(s) listed below will require PA for by Anthem for Medicare 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 precertification 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 | Description | E0761 | Non-Thermal Pulsed High Frequency Radiowaves, High Peak Power Electrom |
Not all PA requirements are listed here. Detailed PA requirements are available to providers on https://providers.anthem.com/ny on the Resources tab or for contracted providers by accessing Availity.com. Providers may also call the number on the back of their patient’s member ID card for Provider Services. UM AROW #: A2023M0415 Medicare services provided by Anthem Blue Cross and Blue Shield, trade name of Anthem HealthChoice HMO, Inc. and Anthem HealthChoice Assurance, Inc., Anthem Blue Cross and Blue Shield HP, trade name of Anthem HP, LLC., or Anthem Blue Cross and Blue Shield Retiree Solutions, trade name of Anthem Insurance Companies, Inc.
Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. NYBCBS-CR-044188-23-CPN43845, CPN-CRMMP-049296-24, NYBCBS-CR-044189-23-CPN43845 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Effective March 1, 2024, prior authorization (PA) requirements will change for the following code(s). The medical code(s) listed below will require PA by Empire BlueCross BlueShield for Medicare 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 precertification 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 | Description | 0239U | Targeted genomic sequence analysis panel, solid organ neoplasm, cell-free DNA, analysis of 311 or more genes, interrogation for sequence variants, including substitutions, ins | 0388U | Oncology (non-small cell lung cancer), next-generation sequencing with identification of single nucleotide variants, copy number variants, insertions and deletions, and struct | 0392U | Drug metabolism (depression, anxiety, attention deficit hyperactivity disorder [ADHD]), gene-drug interactions, variant analysis of 16 genes, including deletion/duplication an | 0397U | Oncology (non-small cell lung cancer), cell-free DNA from plasma, targeted sequence analysis of at least 109 genes, including sequence variants, substitutions, insertions, del | 0400U | Obstetrics (expanded carrier screening), 145 genes by nextgeneration sequencing, fragment analysis and multiplex ligationdependent probe amplification, DNA, reported as carrie | 0401U | Cardiology (coronary heart disease [CAD]), 9 genes (12 variants), targeted variant genotyping, blood, saliva, or buccal swab, algorithm reported as a genetic risk score for a |
Not all PA requirements are listed here. Detailed PA requirements are available to providers on empireblue.com/medicareprovider or for contracted providers by accessing Availity.com. Providers may also call the number on the back of their patient’s member ID card for Provider Services for assistance with PA requirements. UM AROW #: A2023M0444 Services provided by Empire HealthChoice HMO, Inc., Empire HealthChoice Assurance, Inc., or Empire BlueCross BlueShield Retiree Solutions. Empire BlueCross BlueShield Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. lndependent licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield plans. NYBCBS-CR-044226-23-CPN43850, NYBCBS-CR-044227-23-SRS43850 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. UPDATE: This article was originally published as being effective March 1, 2024. The effective date has been delayed to May 1, 2024. Effective May 1, 2024, prior authorization (PA) requirements will change for the following code(s). The medical code(s) listed below will require PA by Anthem for Medicare 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 precertification 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 | Description | Q4272 | Esano a, per square centimeter | Q4273 | Esano aaa, per square centimeter | Q4274 | Esano ac, per square centimeter | Q4275 | Esano aca, per square centimeter | Q4276 | Orion, per square centimeter | Q4277 | Woundplus membrane or e-graft, per square centimeter | Q4278 | Epieffect, per square centimeter | Q4280 | Xcell amnio matrix, per square centimeter | Q4281 | Barrera sl or barrera dl, per square centimeter | Q4282 | Cygnus dual, per square centimeter | Q4283 | Biovance tri-layer or biovance 3l, per square centimeter | Q4284 | Dermabind sl, per square centimeter |
Not all PA requirements are listed here. Detailed PA requirements are available to providers on https://providers.anthem.com/ny or for contracted providers by accessing Availity.com. Providers may also call the number on the back of their patient’s member ID card for Provider Services for assistance with PA requirements. UM AROW #: A2023M0417 Medicare services provided by Anthem Blue Cross, trade name of Anthem HealthChoice HMO, Inc. and Anthem HealthChoice Assurance, Inc., or Anthem Blue Cross Retiree Solutions, trade name of Anthem Insurance Companies, Inc.
Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. NYBCBS-CR-044202-23-CPN43849, CPN-CRMMP-049296-24, NYBCBS-CR-044203-23-CPN43849 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. UPDATE: This article was originally published as being effective March 1, 2024. The effective date has been delayed to May 1, 2024. Effective May 1, 2024, prior authorization (PA) requirements will change for the following code(s). The medical code(s) listed below will require PA by Anthem for Medicare 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 precertification 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 | Description | 0738T | Treatment planning for magnetic field induction ablation of malignant prostate tissue, using data from previously performed magnetic resonance imaging (MRI) examination | 0739T | Ablation of malignant prostate tissue by magnetic field induction, including all intraprocedural, transperineal needle/catheter placement for nanoparticle installation and int |
Not all PA requirements are listed here. Detailed PA requirements are available to providers on https://providers.anthem.com/ny or for contracted providers by accessing Availity.com. Providers may also call the number on the back of their patient’s member ID card for Provider Services for assistance with PA requirements. UM AROW #: A2023M0443 Medicare services provided by Anthem Blue Cross and Blue Shield, trade name of Anthem HealthChoice HMO, Inc. and Anthem HealthChoice Assurance, Inc., Anthem Blue Cross and Blue Shield HP, trade name of Anthem HP, LLC., or Anthem Blue Cross and Blue Shield Retiree Solutions, trade name of Anthem Insurance Companies, Inc.
Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. NYBCBS-CR-044240-23-CPN43832, CPN-CRMMP-049296-24, NYBCBS-CR-044241-23-CPN43832 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Effective March 1, 2024, prior authorization (PA) requirements will change for the following code(s). The medical code(s) listed below will require PA by Empire BlueCross BlueShield for Medicare 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 precertification 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 | Description | 33275 | Transcatheter removal of permanent leadless pacemaker, right ventricular | 33274 | Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (such as fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (such as interrogation or programming), when performed |
Not all PA requirements are listed here. Detailed PA requirements are available to providers by visiting Medicare Advantage Providers | EmpireBlue.com > Providers > Claims > Prior Authorization, or for contracted providers by accessing Availity.com. Providers may also call number on the back of their patient’s member ID card for Provider Service for assistance with PA requirements. UM AROW 4290 Services provided by Empire HealthChoice HMO, Inc., Empire HealthChoice Assurance, Inc., or Empire BlueCross BlueShield Retiree Solutions. Empire BlueCross BlueShield Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. lndependent licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield plans. NYBCBS-CR-042755-23-CPN41430 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Effective January 1, 2024, Empire BlueCross BlueShield updated the Related Coding section of the Pharmaceutical Waste – Professional and Facility reimbursement policy to include Modifier JZ (zero drug amount discarded or not administered to any patient) as a new informational modifier. As a reminder, the intent of this policy is to require providers to use the most cost-effective vial or combination of vials of pharmaceutical when procuring and preparing a dose for administration to avoid pharmaceutical wastage. This applies to any non-self-administered drug or biologic dosage prepared from a single-dose vial (SDV). For specific policy details, visit empireblue.com/provider/policies/reimbursement/. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-040643-23 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Empire BlueCross BlueShield (Empire) is excited to announce a new High Performing Provider (HPP) designation to care providers meeting certain cost and quality metrics. Through this new designation, Empire is expanding our consumer tools and content to assist members in making more informed and personalized healthcare decisions. Initially, the designation will focus on certain types of professional providers, but it may be broadened to include other care provider types in the future. The High Performing Provider designation will launch on February 1, 2024. Empire may highlight HPPs in various ways, including, but not limited to: - Special opportunities to participate in product offerings.
- When members contact Empire with requests for referral options.
- Placing a designation in Empire’s Care and Cost Finder. This would be in addition to Empire’s existing tool in Care and Cost Finder called Personalized Match that provides Empire members with the option to search for in-network care providers through a specialized sorting tool that considers certain cost and quality metrics, as well.
For more information on the HPP designation, you can view the designation methodology, or to know if your practice will receive the designation, send an email to HPPdesignation@empire.com. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-045691-23-CPN44770, NYBCBS-CM-045689-23-CPN44770 ATTACHMENTS (available on web): designation methodology (pdf - 0.16mb) Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. The Federal Employee Program® (FEP) will now be issuing ID cards at the member level. These cards will be issued based on the member’s plan coverage. To implement this change, FEP is sending updated member ID cards in the fall of 2023 and early 2024. Members who have not received their new ID card yet can continue to use their existing ID cards until the new ID card is received. Also new for 2024Starting January 1, 2024, FEP will offer a new prescription drug benefit called FEP Medicare Prescription Drug Program (MPDP). MPDP is an optional prescription drug benefit available for members who are Medicare eligible, and part of the member’s plan coverage. For members enrolled in MPDP, their new ID card will display their MPDP ID number. Do not confuse this with the existing Member ID card. You will still need to use the Member ID for claims submissions. Make copies of all ID cards for your records. Please note members can disenroll from or enroll in MPDP later, and their information could change. Below is a sample of the new Member ID card with MPDP enrollment. 
The following instructions still apply when submitting claims: - Use a valid member ID number.
- Include the patient’s first and last name.
- Name the health plan policy owner (insured) who is responsible for the policy.
For further information regarding our new Member ID cards or MPDP, contact the FEP Customer Service number on the back of the member’s ID card. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-044860-23 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. To view the 2024 benefits and changes for the Federal Employee Program® (FEP), go to Fepblue.org and select Tools and Resources, then select Brochure and Resources. Here you will find the Service Benefit Plan Brochure, Benefit Plan Summaries, and Quick Reference Guides on information for 2024. If you have questions, contact FEP customer service at 800-522-5566. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-043907-23-CPN43800 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. CarelonRx mail service pharmacy will change to CarelonRx Pharmacy on January 1, 2024. This pharmacy change does not affect the way CarelonRx works with care providers. There are no changes to the prior authorization process, how claims are processed, or level of support. This change does not impact your patients’ benefits, coverage, or how their medications are filled. When e-prescribing orders to the mail service pharmacy: - Prescribers will need to choose CarelonRx Pharmacy, not CarelonRx Mail, if searching by name.
- If searching by NPI (National Provider Identifier), the NPI is changing to 1568179489.
We are taking steps to ensure a smooth transition to our new home delivery pharmacy for your patients: - Patients will receive a letter to alert them of their new pharmacy.
- If a patient has refills left, we will move them to CarelonRx Pharmacy, and we’ll also transfer auto refills.
- If a patient doesn’t have any refills left of their medication(s), CarelonRx Pharmacy will contact you to obtain a new prescription.
- If a patient is taking a controlled substance, CarelonRx Pharmacy will contact you to obtain a new prescription.
- All prior authorizations will be transitioned to CarelonRx Pharmacy.
CarelonRx Pharmacy will deliver an enhanced, digital-first solution to your patients to improve adherence and lower costs, while removing barriers associated with traditional retail and mail order pharmacy models. Some highlights include: - 24/7 text or chat (digitally) directly with our pharmacists at any time.
- Enhanced end-to-end order status tracking from prescription order to delivery.
- Acceptance of coupons; auto apply manufactured discounts (e-voucher), if applicable.*
- Free delivery of their 90-day supply, directly to a patient’s door.
* Not available for Medicare or Medicaid patients. CarelonRx, Inc. is an independent company providing pharmacy benefit management services on behalf of the health plan. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-045615-23-CPN45533 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Effective for dates of service on and after January 1, 2024, the following specialty pharmacy codes from current or new Clinical Criteria documents will be included in our existing specialty pharmacy medical step therapy review process. Step therapy review will apply upon prior authorization initiation or renewal in addition to the current medical necessity review of all drugs noted below. Clinical Criteria CC-0041 will be adding step therapy, preferring Enspryng and Uplizna, for the indication of neuromyelitis optica spectrum disorder. The searchable list of specific Clinical Criteria is publicly available on our provider website. Clinical Criteria | Status | Drug(s) | HCPCS codes | CC-0041 | Non-preferred | Soliris | J1300 | CC-0041 | Preferred | Enspryng | C9399, J3590 | CC-0041 | Preferred | Uplizna | J1823 |
We look forward to working together to achieve improved outcomes. Empire BlueCross BlueShield HealthPlus is the trade name of HealthPlus HP, LLC, an independent licensee of the Blue Cross Blue Shield Association. CPN46328, NYBCBS-CD-046618-23, NYBCBS-CD-039000-23-CPN38894 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. The Empire BlueCross BlueShield (Empire) pre-service clinical review of non-oncology specialty pharmacy drugs will be managed by the Medical Specialty Drug Review team of Empire. Oncology drugs will be managed by Carelon Medical Benefits Management, Inc., a separate company. The following Clinical Criteria documents were endorsed at the September 27, 2023, Clinical Criteria meeting. To access the Clinical Criteria information, visit this link. New Clinical Criteria effective March 1, 2024 The following Clinical Criteria are new: - CC-0250 Veopoz (pozelimab-bbfg)
- CC-0251 Ycanth (cantharidin)
Revised Clinical Criteria effective March 1, 2024 The following Clinical Criteria were revised and might result in services that were previously covered but may now be found to be not medically necessary: - CC-0018 Pompe Disease [Lumizyme (alglucosidase alfa), Nexviazyme (avalglucosidase alfa-ngpt), Pombiliti (cipaglucosidase alfa-atga)]
- CC-0020 Natalizumab Agents (Tysabri, Tyruko)
- CC-0021 Fabrazyme (agalsidase beta)
- CC-0046 Zinplava (bezlotoxumab)
- CC-0068 Growth Hormones
- CC-0233 Rebyota (fecal microbiota, live — jslm)
Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-044076-23 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Visit the Drug Lists page on our provider website at https://www.empireblue.com/ms/pharmacyinformation/home.html for more information about: - Copayment/coinsurance requirements and their applicable drug classes.
- Drug lists and changes.
- Prior authorization criteria.
- Procedures for generic substitution.
- Therapeutic interchange.
- Step therapy or other management methods subject to prescribing decisions.
- Any other requirements, restrictions, or limitations that apply to using certain drugs.
The commercial and exchange drug lists are posted to the website quarterly on the first day of the month in January, April, July, and October. To locate the exchange, select Formulary and Pharmacy Information, and scroll down to Select Drug Lists. This drug list is also reviewed and updated regularly as needed. Federal Employee Program pharmacy updates and other pharmacy related information may be accessed at www.fepblue.org > Pharmacy Benefits. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. NYBCBS-CM-018447-23, NYBCBS-CM-041070-23-CPN41054, NYBCBS-CM-044436-23-CPN44369 Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem. Effective for dates of service on and after December 1, 2023, updated step criteria for Iron Agents found in Clinical Criteria document CC-0182 will be implemented. The preferred product list is being expanded. Please refer to the Clinical Criteria page for more information. Clinical UM Guidelines are publicly available on the care provider website. Visit the Clinical Criteria page to search for specific criteria. Clinical UM Guidelines | Preferred drug(s) | Nonpreferred drug(s) | CC-0182 | Feraheme (ferumoxytol) Ferrlecit (sodium ferric gluconate/sucrose complex) Infed (iron dextran) Venofer (iron sucrose) | Injectafer (ferric carboxymaltose) Monoferric (ferric derisomaltose) |
We’re committed to active involvement with our care provider partners and going beyond the contract to create a real impact on the health of our communities. Services provided by Empire HealthChoice HMO, Inc., Empire HealthChoice Assurance, Inc., or Empire BlueCross BlueShield Retiree Solutions. Empire BlueCross BlueShield Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. lndependent licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield plans. NYBCBS-CR-038911-23-CPN38505 |