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  • Access to Care and Delivery System > Hepatitis C Testing

    Effective January 1, 2014, a hepatitis C screening test must be offered to every individual born between 1945 and 1965 when one of the following criteria is met:

    • Inpatient of a hospital
    • Receiving primary care services in the outpatient department of a hospital
    • In a freestanding diagnostic and treatment center
    • From a physician, physician assistant or nurse practitioner providing primary care regardless of setting type

      If the test is reactive, follow-up health care including an HCV RNA test must be offered onsite or by referral.

      For more information on hepatitis C, please visit the New York State Department of Health website at https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_c/provider.htm.

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      Glossary terms found on this page:

      An institution which provides inpatient services under the supervision of a physician, and meets the following requirements:

      • Provides diagnostic and therapeutic services for medical diagnosis, treatment and care of injured and sick persons and has, as a minimum, laboratory and radiology services and organized departments of medicine and surgery
      • Has an organized medical staff which may include, in addition to doctors of medicine, doctors of osteopathy and dentistry
      • Has bylaws, rules and regulations pertaining to standards of medical care and service rendered by its medical staff
      • Maintains medical records for all patients
      • Has a requirement that every patient be under the care of a member of the medical staff
      • Provides 24-hour patient services
      • Has in effect agreements with a home health agency for referral and transfer of patients to home health agency care when such service is appropriate to meet the patient's requirements

      Service provided after the patient is admitted to the hospital. Inpatient stays are those lasting 24 hours or more.

      Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.

      The state regulatory agency that certifies reimbursement methods and rates to hospitals and reviews HMO activities in the state of New York. Also called NYSDOH.

      A medical practitioner or covered facility recognized by EmblemHealth for reimbursement purposes. A provider may be any of the following, subject to the conditions listed in this paragraph:

      • Doctor of medicine
      • Doctor of osteopathy
      • Dentist
      • Chiropractor
      • Doctor of podiatric medicine
      • Physical therapist
      • Nurse midwife
      • Certified and registered psychologist
      • Certified and qualified social worker
      • Optometrist
      • Nurse anesthetist
      • Speech-language pathologist
      • Audiologist
      • Clinical laboratory
      • Screening center
      • General hospital
      • Any other type of practitioner or facility specifically listed in the member's Certificate of Insurance as a practitioner or facility recognized by EmblemHealth for reimbursement purposes

      A provider must be licensed or certified to render the covered service. The covered service must be within the scope of the Provider's license or certification.

      A recommendation by a physician that an enrollee receive care from a specialty physician or facility.

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