City of NY Retirees Moving to New Medicare Advantage Plan in 2022

09/08/2021

The City of New York recently awarded its group retiree business to Retiree Health Alliance, a collaboration between EmblemHealth and Empire BlueCross BlueShield (BCBS). Effective Jan. 1, 2022, Medicare-eligible City of New York retirees will transition to Retiree Health Alliance’s NYC Medicare Advantage Plus plan.

The NYC Medicare Advantage Plus plan is a Medicare Advantage PPO New Claims Process

Providers will submit ALL claims (facility, professional & ancillary) to Empire BCBS and Empire BC or local Blue plan depending on the service location.

Do not submit claims to EmblemHealth or Original Medicare. That will only delay processing and payment.
plan that allows retirees to receive services from both in-network and out-of-network providers. Out-of-network providers must be eligible to receive Medicare payment to provide care to NYC retirees. Under this new plan, City of New York retirees will have no difference in cost-share for both in-network and out-of-network services. NYC Medicare Advantage Plus offers the same hospital and medical benefits Medicare covers, as well as additional benefits Medicare does not provide such as annual routine physical exams, hearing, a health and fitness tracker, the LiveHealth Online telehealth app, and SilverSneakers®.

 

As of Jan. 1, 2022, the network arrangement for the NYC Medicare Advantage Plus plan will be as follows:

  • EmblemHealth participating professional providers including chiropractors, occupational therapists, and physical therapists
  • Empire BCBS participating facilities and behavioral health providers
  • EmblemHealth Network for professional providers is for services obtained in New York, the Bronx, Kings, Queens, Richmond, Nassau, Suffolk, Westchester, Orange, Rockland, Putnam, Dutchess, and Sullivan counties.
  • EmblemHealth Neighborhood Care Centers
  • BlueCross and BlueShield Medicare Advantage PPO professional and facility providers outside of the counties listed above will be considered participating.

 

Currently, City of New York retirees’ claims are processed by Medicare as primary and then by EmblemHealth (for professional services) or by Empire BlueCross BlueShield (for facility services) as supplemental coverage under the EmblemHealth/Empire BCBS Senior Care plan.

Beginning Jan. 1, 2022, under the NYC Medicare Advantage Plus plan, providers will change billing processes as follows:

  • Providers will submit all claims (facility, professional & ancillary) to Empire BCBS and Empire BC or local Blue plan depending on the service location.
  • Providers will not transmit any claims to Original Medicare or EmblemHealth.
  • Claims can be submitted electronically utilizing existing payer IDs already established for Empire BCBS and Empire BC or paper submission (UB-04 or CMS-1500 form) to your local Blue plan.

 

Additional information regarding the NYC Medicare Advantage Plus plan will be released as it becomes available and will be posted in future issues of this newsletter, on our website, and through other traditional and digital channels. Please check back regularly for updates.

Provider Update