In This Issue:

HIP Service Area Expansion Affects GHI HMO Providers

New Prior Approval List

New Web Usage Requirements for GHI HMO Network Providers

New EmblemHealth Radiation Therapy Program and EmblemHealth Cardiology Imaging Program and HIP Radiology Programs Apply to More Members

Updated Fax Forms for: EmblemHealth Injectable Drug Utilization Management Program

EmblemHealth Consolidates Post Office Boxes for GHI HMO and EmblemHealth Medicare PPO

Claims Corner

Medicaid and Medicare Updates

Behind the Scenes

Case Management Programs

Stressing the Importance of Prenatal Visits

Well-Child Visits

High-Risk Medications for Elderly Patients

Healthful Aging Starts With Lifestyle Changes and Preventive Screenings

Talking With Patients About Urinary Incontinence

Treating Rheumatoid Arthritis

Assisting Patients Living With HIV

Treating Low Back Pain

Asthma Management

CPT Codes for Tobacco Cessation Counseling

Clinical Corner

News&Notes Archive

New Prior Approval List

Starting November 1, 2012, a new prior approval list will apply to all commercial and state-sponsored benefit plans underwritten by GHI HMO Select, Inc., HIP Health Plan of New York, HIP Insurance Plan of New York and Vytra Health Plans Managed Systems. Aside from a minor exception regarding the timing of submitting prior approval requests for PT/OT and chiropractic services, all prior approval rules for GHI HMO and HIP HMO will be the same. Further, our secure provider Web site is being modified to enable GHI HMO providers to submit their prior approval requests using the same online screens currently in use for HIP. This will allow GHI HMO providers to use the secure site to review the status of prior approval requests for all services, not just those related to inpatient care.

Please note: Due to a recent New York State mandate, prior approvals are no longer required for speech therapy related to autism spectrum disorder (ASD).

Effective January 1, 2013, a new prior approval list will apply to EmblemHealth Medicare HMO/PPO/ASO members. More information will be provided closer to the implementation date.


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