CommercialSeptember 1, 2022

September 2022 Newsletter

Administrative

AdministrativeCommercialAugust 31, 2022

Continuing to explore the intersection of race and disability

AdministrativeCommercialAugust 31, 2022

Monkeypox resources and recommendations for our care providers

AdministrativeCommercialAugust 31, 2022

New patient evaluation and management services when reported for the same patient within the last three years

AdministrativeCommercialAugust 31, 2022

Drug code billing reminder

AdministrativeCommercialAugust 31, 2022

Important information about women’s preventive care visits

AdministrativeCommercialAugust 31, 2022

Empire to accept Hospital in Home services

AdministrativeCommercialAugust 31, 2022

CAA: Current provider directory information is key for members and providers to engage with you seamlessly

Digital SolutionsCommercialAugust 31, 2022

Updates to the Claim Attachment workflow

Policy Updates

Reimbursement PoliciesCommercialAugust 31, 2022

Reimbursement policy update - Modifier Rules (Professional)
Material Adverse Change (MAC)

Reimbursement PoliciesCommercialAugust 31, 2022

Reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) (Professional)

Reimbursement PoliciesCommercialAugust 31, 2022

Reimbursement policy update - Modifier 66: Surgical Teams (Professional)

Products & Programs

Products & ProgramsCommercialAugust 31, 2022

New Back Pain Management Program

Federal Employee Program (FEP)CommercialAugust 31, 2022

OBRA 93 claim filing for Federal Employee Program

PharmacyCommercialAugust 31, 2022

Specialty pharmacy updates - September 2022
Material Adverse Change (MAC)

PharmacyCommercialAugust 31, 2022

Clinical Criteria updates for specialty pharmacy
Material Adverse Change (MAC)

PharmacyCommercialAugust 31, 2022

Update to formulary lists for Commercial health plan pharmacy benefit

State & Federal

State & FederalMedicaidAugust 31, 2022

Reimbursement policy update: Modifiers 25 and 57: Evaluation and Management with Global Procedures (Policy G- 06003), (Informational only)

State & FederalMedicaidAugust 31, 2022

Clinical Criteria updates

State & FederalMedicaidAugust 31, 2022

New specialty pharmacy medical step therapy requirements

State & FederalMedicaidAugust 31, 2022

Enhancing claims attachment processes through digital applications

State & FederalMedicaidAugust 31, 2022

Alcohol use disorders linked to chronic diseases

State & FederalMedicare AdvantageAugust 31, 2022

Prior authorization requirement changes effective December 1, 2022

State & FederalMedicare AdvantageAugust 31, 2022

Reimbursement policy update: Modifiers 25 and 57: Evaluation and Management with Global Procedures (Policy G- 06003)

State & FederalMedicare AdvantageAugust 31, 2022

Enhancing claims attachment processes through digital applications

State & FederalMedicare AdvantageAugust 31, 2022

Empire BlueCross BlueShield expands specialty pharmacy precertification list – effective 11/1/2022

State & FederalMedicare AdvantageAugust 31, 2022

Empire BlueCross BlueShield expands specialty pharmacy precertification list - effective 12/1/2022

State & FederalMedicare AdvantageAugust 31, 2022

Reminder: AIM prior authorization phone number change for Medicare

State & FederalMedicare AdvantageAugust 31, 2022

Keep up with Medicare news - September 2022
View this Medicare article:
  • Clinical Criteria Updates
  • Medicare telehealth services during the Coronavirus (COVID-19) public health emergency (PHE) FAQ