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

Assisting Patients Living With HIV

Through our Complex Case Management department, we offer an HIV Case Management program to help patients with HIV identify and obtain care, learn about disease process and management, adhere to complex medication schedules and link up with community resources.

Our specially trained HIV case managers provide confidential disease-focused assessments, interventions and monitoring to help patients with HIV maximize their health and wellness outcomes. They work with patients to break through barriers to effective care and navigate and access health services. In a HIPAA-compliant manner, our case managers also advocate for and liaise between our members and their families, caregivers and clinicians.

HIV Care Guidelines: The Basics
Members living with HIV should have a minimum of two outpatient care visits per year (one in each half of the year), two viral load tests per year (again, one in each half of the year) and be screened yearly for syphilis. In addition, antiretroviral medication adherence is paramount to successful management of HIV and AIDS. In the context of a trusting, confidential relationship, HIV case managers help members overcome financial, psychosocial and functional barriers to achieving care standards and adherence.

For more information, please consult our clinical practice guidelines for HIV/AIDS management, adopted from recognized sources. To refer a patient to the EmblemHealth HIV Case Management program, please call or have the member call 1-800-447-0768.

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