NY Medicaid Provider Empire BlueCross BlueShield
Behavioral health providers. We work collaboratively with hospitals, group practices and independent behavioral healthcare providers, community and government agencies, human service districts, and other resources. This enables Empire to meet the needs of members with mental health and substance use disorders as well as those with intellectual
Actived: 5 days ago
Behavioral health NY Provider
(1 days ago) Behavioral health providers can be accessed directly by Empire members. Members do not have to contact Empire for a referral. For contact information including fax numbers for behavioral health requests and notifications, please visit the Contact Us page.
Plan Information NY Provider
(9 days ago) Health records are shared (either electronically or paper) among providers so that services are not duplicated or neglected. The health home services are provided through a network of organizations — providers, health plans and community-based organizations. When all the services are considered collectively, they become a virtual Health Home.
Patient Care Overview NY Provider
(3 days ago) Behavioral health. The Behavioral Health provider network of Empire BlueCross BlueShield HealthPlus includes psychiatrists, psychologists, social workers, psychiatric nurses, other mental health providers and employee assistance healthcare professionals.
Prior Authorization Requirements NY Provider
(Just Now) Behavioral health services billed with the following revenue codes ALWAYS require prior authorization: 0240–0249 — All-inclusive ancillary psychiatric 0901, 0905–0907, 0913, 0917 — Behavioral health treatment services
Pharmacy Information NY Provider
(1 days ago) Health and Recovery Plan (HARP) preferred drug list. Prior authorization requests. Some drugs, drug combinations and drug doses require prior authorization (PA). To submit electronic prior authorization (ePA) requests online, use Availity*. Prior authorization phone and fax numbers.
Contact Us NY Provider
(1 days ago) Behavioral health outpatient precertification fax: Fax: 1-866-877-5229. Retail pharmacy fax: Fax: 1-844-490-4877. Medical injectables fax: Fax: 1-844-493-9206. Disease management. Our DM care managers are licensed nurses and social workers and are available from 8:30 a.m. to 5:30 p.m. Eastern time, Monday through Friday. Confidential voice mail
Manuals, Policies & Guidelines NY Provider
(8 days ago) Behavioral health quick reference guide; Medical policies and clinical UM guidelines. Medical policies address the medical necessity of new services or procedures and new applications of existing services or procedures. Clinical UM guidelines focus on detailed selection criteria, goal length of stay, and location for generally accepted
COVID-19 updates Empire BlueCross BlueShield HealthPlus
(2 days ago) COVID-19 information. Empire BlueCross BlueShield HealthPlus (Empire) is committed to helping our members gain timely access to care and services in a way that places the least burden on the healthcare system. We have established a team of experts to closely monitor developments and how they will impact our members and healthcare provider partners.
Provider Forms NY Provider
(6 days ago) Attachment Form B: Patient Discharge Care Notification Form. EDI registration form for new submitters. Form C: Billing Summary Solid Organ Transplant. Form D: Billing Summary Form Bone Marrow/Stem Cell Transplant. Practice Profile Update Form. Provider Coding education Webinars and On-demand Trainings are Now Available.
Case management NY Provider
(9 days ago) Talk to the member about their health and how they’re handling different parts of their life. Our case managers are here to help you. If you have a member in your care who would benefit from case management, please call Provider Services at 1-800-450-8753. Members can also call our 24/7 NurseLine at 1-800-300-8181, available 24 hours a day, 7
Resources Overview NY Provider
(Just Now) The behavioral health provider network at Empire includes psychiatrists, psychologists, social workers, psychiatric nurses, and other mental health and employee assistance healthcare professionals. Our facility network includes hospital inpatient units, residential treatment centers, partial hospitalization programs, and intensive outpatient
Claims Submissions and Disputes NY Provider
(9 days ago) Select the health plan. From the Payer Spaces home page, select the Applications tab. Select the Clear Claims Connection tile. Related resources. For a complete guide to the Provider Claim Payment Dispute Process, please refer to the provider manual.
Member rights and responsibilities NY Provider
(7 days ago) Understand the specific health problems and participate in developing mutually agreed-upon treatment goals as much as they are able; Discuss problems they may have with following their providers’ directions; Follow plans and instructions for the care they have agreed to with their practitioners
Electronic Data Interchange (EDI) NY Provider
(5 days ago) Empire BlueCross BlueShield HealthPlus (Empire) uses Availity* as its exclusive partner for managing all electronic data interchange (EDI) transactions. EDI, including electronic remittance advices (ERAs) and electronic funds transfers (EFTs), allows for a faster, more efficient and cost-effective way for providers and employers to do business.
Provider Training Academy NY Provider
(6 days ago) A training resource to increase cultural and disability competency to help effectively support the health and healthcare needs of your diverse patients. All contracted healthcare providers with Empire should complete the online cultural competency training.
(5 days ago) Empire is offering a new comprehensive and affordable health insurance program. The Essential Plan is a health benefit coverage program for low-to moderate-income residents who would otherwise be ineligible to purchase coverage through the Health Insurance Marketplace or qualify for Medicaid. We are a licensed Health Maintenance Organization (HMO).
Reimbursement Policies NY Provider
(Just Now) Reimbursement Policies. We want to assist physicians, facilities and other providers in accurate claims submissions and to outline the basis for reimbursement if the service is covered by a member’s benefit plan. Keep in mind that determination of coverage under a member's benefit plan does not necessarily ensure reimbursement. Please note:
Disease Management NY Provider
(2 days ago) The mission of the DM department is to improve the health and quality of life for Empire BlueCross BlueShield HealthPlus (Empire) members by encouraging member self-care efforts, coordinating healthcare education and providing interventions along the continuum of care. DM services include:
Join Our Network NY Provider
(7 days ago) We are happy to talk with you about joining the Empire provider network If you have questions or are not yet ready to start the online application process. If you have questions regarding the Empire provider application process, please call 1-800-992-BLUE (2583), and select the following prompts: Option 1: Participation and Credentialing
NYS Medicaid Prior Authorization Request Form For
(7 days ago) This is a new medication and/or new health plan for the patient. If checked, go to question 1 This is continued therapy previously covered by the patient’s current health plan. If checked, approx. date initiated _____/_____. Go to question 5 1. Does the drug require a dose titration of either multiple strengths and/or multiple doses per day
Anthem Blue Cross and Blue Shield Indiana Medicaid
(7 days ago) Training for health care professionals and their staff regarding enrollment, covered benefits, managed care operations and linguistic services. Member support services including health education referrals, event coordination and coordination of cultural and linguistic services.
(7 days ago) subsidiary health plans provide health care coverage exclusively to low-income families, seniors and people with disabilities. Empire is an award-winning Prepaid Health Service Plan (PHSP) that provides and manages government-sponsored health insurance programs to eligible members in …
Overpayment refund notification form
(6 days ago) Important Note: You are not permitted to use or disclose Protected Health Information about individuals who you are not currently treating or are not enrolled to your practice. This applies to Protected Health Information accessible in any online tool, sent in any medium including mail, …
Benefits Partners NY Provider
(Just Now) AIM Specialty Health is an independent company providing diagnostic and imaging service authorizations on behalf of Empire BlueCross BlueShield HealthPlus. HearUSA is an independent company providing hearing services on behalf of Empire BlueCross BlueShield HealthPlus.
Referrals NY Provider
(Just Now) For more information about case management related to pregnancy and maternal health, please visit our Pregnancy & Maternal Child page. Please note: Members do not need a referral from their PCP to access behavioral health services; however, the PCP should actively engage in identifying the need for behavioral health services for their patients
Healthy Rewards Program
(4 days ago) To help your practice, all Healthy Rewards activities are tied to HEDIS® scores and/or health initiatives. They include: Healthy activities Who’s eligible Reward Frequency 7-Day Follow-Up After Behavioral Health Discharge M, F, ages 6 and older $25 1 per 12 months Chlamydia Screening in Women F, ages 16 to 24 $25 1 per 12 months
(4 days ago) ☐ Long-term services and supports/long-term care ☐ Home health ☐ Durable medical equipment ☐ Diagnostic study ☐ Hospice ☐ Office visit ☐ Personal care services ☐ Other: Place of service: ☐ Hospital ☐ Ambulatory surgery center ☐ Office ☐ Home ☐ Independent lab ☐ Nursing facility ☐ Other:
Reimbursement Policy Definitions NY Provider
(2 days ago) An approval process for requested medical services, either by a servicing health care provider or the patient, to determine if a service is covered for reimbursement; prior authorization is determined by eligibility, plan benefits and medical necessity of the service being requested. Recoupment of payments:
You can take steps today toward a healthier future!
(8 days ago) Preventive health guidelines May 2019 You can take steps today toward a healthier future! Your health plan pays for certain tests to find disease early, routine wellness exams, and shots to help you and your family stay well. This is called preventive care. Using this guide This guide does not mention every condition and treatment.
Empire BlueCross BlueShield HealthPlus Provider Directory
(9 days ago) providers and strong ties with community and health care groups. Empire Managed Long-Term Care is a managed long-term care plan for Medicaid-eligible people who: • Have chronic and disabling conditions and • Are at least 18 years old and • Require long-term care Empire is the first place you call for help with your health care.
Provider Bulletin Information from Empire BlueCross
(3 days ago) services as well as mental health and substance use disorders services, where medically appropriate if all other requirements for a covered health service are met. This applies to fully insured employer plans, individual plans, and Medicare plans and Medicaid plans, where permissible. Self-insured plan sponsors may opt out of this program.
Community Referrals for Health Home Services
(6 days ago) o Health Homes and MCPs have access to assignment information in the HCS portal and should check an individual’s assignment status prior to making a referral. If the individual is already assigned to a Health Home, that Health Home should be contacted to discuss the appropriate course of action.
Behavioral Health Reference Guide
(2 days ago) Behavioral Health Provider) and the specialties eligible outlined in BT2020122 listed in table 1.} Providers enrolled under the new Indiana Medicaid type and specialty for mid-levels (BT2020108) and (BT2020122) do not bill with a modifier.
Serving Hoosier Healthwise, Healthy Indiana Plan and
(1 days ago) • The belief systems related to health, healing and wellness are as diverse as the populations we serve. • Culture and socioeconomic concerns influence help-seeking behaviors and attitudes toward health care providers and services. • Individual preferences affect traditional and nontraditional approaches to health …
837 Institutional Health Care Claim
(4 days ago) The Healthcare Provider Taxonomy code set divides health care providers into hierarchical groupings by type, classification, and specialization, and assigns a code to each grouping. The Taxonomy consists of two parts: individuals (e.g., physicians) and non-individuals (e.g., ambulatory health care facilities).
Retroactive eligibility prior authorization/utilization
(8 days ago) from their computer systems. EDI is available for most common health care business transactions. For more information on EDI, contact the Anthem EDI Solutions Helpdesk at: Phone: 1-800-470-9630 Hours of operation: Monday to Friday, 8 a.m. to 4:30 p.m. ET Email: [email protected] Paper claims
Learn about Availity NY Provider
(1 days ago) Availity is a portal for providers and staff that simplifies provider transactions such as eligibility and benefits inquiry, claims submission, claims status inquiry and authorizations.. Find these tools on Availity Patient registration: Get real-time patient eligibility and benefits reports, including current and historical coverage information, plus detailed co-insurance, co-payment, and
Provider Dispute Resolution Request Form
(3 days ago) For health plan use only: Tracking number: _____ Provider ID:_____ Anthem Blue Cross and Blue Shield Provider Dispute Resolution Request Form Page 2 of 2 Use this page only for multiple like claims (disputed for the same reason). Fields with an asterisk (*) are required. Provider name
A streamlined and innovative approach to member engagement
(3 days ago) HNS: Health Needs Survey W15: Well-Child Visits in the First 15 Months of Life CDC: Comprehensive Diabetes Care HPV: Human Papillomavirus W34: Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life CHL: Chlamydia Screening in Women IET: Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence AWC: Adolescent Well
Mental Health and Substance Use Nonacute Services
(8 days ago) Mental Health and Substance Use Nonacute Services (Outpatient Treatment) Request Form Page 2 of 5 Symptoms (Include those that are the focus of current treatment.) Progress since last review Functional impairments/strengths (For example, note interpersonal relations, personal hygiene, work/school, etc.) Recovery environment
837 Professional Health Care Claim
(3 days ago) 837P Health Care Claim Companion Document - Encounter Page 2 of 11 Release 1 (August 2015) 005010X222A1 Empire BlueCross BlueShield HealthPlus is the trade name of HealthPlus, LLC, an independent licensee of the Blue Cross and Blue Shield Association.
Anthem Blue Cross and Blue Shield Serving members enrolled
(3 days ago) •The U.S. Department of Health and Human Services has issued a rule finalizing October 1, 2015, as the new compliance date for health care providers, health plans and health care clearinghouses to transition to ICD-10. •This deadline allows providers, insurance companies and others in …
Pregnancy & Maternal Child Services NY Provider
(1 days ago) Empire is here to support providers, pregnant members and their little ones on the way. If you would like more information about the OB Case/Care Management program or have a patient who would benefit from care management, call Provider Services at 1-800-450-8753, Monday to Friday 8:30 a.m. to 5:30 p.m. For after-hours support, call the 24/7
Anthem Blue Cross and Blue Shield Serving Hoosier
(3 days ago) Access to physical health . Anthem Blue Cross and Blue Shield (Anthem) members have access to quality health care 24/7. Primary medical providers (PMPs) must have a system in place to ensure that members can call after hours with medical questions or concerns. Anthem monitors PMP compliance with after-hours access on a regular basis.
Official CMS Industry Resources for the ICD-10 Transition
(2 days ago) forms/superbills, practice management system, electronic health record system, contracts, and public health and quality reporting protocols. It is likely that wherever ICD-9 codes now appear, ICD-10 codes will take their place. Talk with your practice management system vendor about accommodations for …
Utilization management and claims submission for SOMOS …
(9 days ago) To learn more about applying for health insurance, including Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans through NY State of Health, The Official Health Plan Marketplace, visit . www.nystateofhealth.ny.gov. or call . 1-855-355-5777. NYE-NU-0299-21 March 2021. Utilization management and claims submission for SOMOS members
Availity appeals and Interactive Care Reviewer
(8 days ago) Important information It is a violation of HIPAA regulations to share credentials to a system that contains personally identifiable information (PII)/personal health information (PHI). Please do not share an Availity user ID with others.
Acquisition of Beacon Health Options
(8 days ago) Acquisition of Beacon Health Options This communication applies to the Medicaid and Medicare Advantage programs for Anthem Blue Cross and Blue Shield (Anthem). Anthem, Inc. completed its acquisition of Beacon Health Options (Beacon), a large behavioral health organization that serves more than 36 million people across the country.