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

Treating Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a complex and progressive disease that can affect functionality and quality of life. Early diagnosis and treatment of RA is critical to living a productive lifestyle. As reported by the Arthritis Foundation, current studies show that early and aggressive treatment of RA can limit joint damage, which can in turn reduce the chance for loss of movement, decreased ability to work, increased medical costs and potential need for surgery. It can even prevent long-term joint damage and disability.

Upon a positive RA diagnosis, please assess the benefits of prescribing disease-modifying anti-rheumatic drugs (DMARDs). Please note that the following DMARDs will require prior approval under the EmblemHealth Injectable Drug Utilization Program, which is managed by ICORE.*

  • Orencia (J0129)
  • Remicade (J1745)
  • Rituxan (J9310)

Collaboration between a primary care physician and a rheumatologist can help ensure proper diagnosis of and care management for patients with RA. For more information, please consult our clinical practice guidelines for rheumatoid arthritis management, adopted from recognized sources.

* Members in the following plans are not part of our Injectable Drug Utilization Program and are exempt from prior approval for the above-mentioned injectable drugs: commercial plans underwritten by GHI (EmblemHealth EPO/PPO and GHI EPO/PPO); NY Bridge Plan (also underwritten by GHI); and HIP members assigned to a Montefiore (CMO) or Health Care Partners (HCP) PCP.

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