July 2019 In The Know


Update: Pre-authorization list changes now targeted for September 1

September 1 is the new start date for HIP’s Commercial and Medicaid supplemental pre-authorization rules for specific sites of service. This change reduces your need to seek pre-authorization based on the member’s type of plan and selected site of service. Click here for more details.

EmblemHealth offering new ASO Bridge Network

Starting September 1, EmblemHealth will offer access to all commercial contracted networks, as well as administrative services to self-funded groups, under the umbrella name “Bridge Network.” This update will also change our process for sending claim payments to providers. More information will soon be available on the provider website.

Reducing HPV related cancers

EmblemHealth is working in collaboration with the American Cancer Society, New York State and City Departments of Health, and other New York State health plans to encourage more providers to recommend the HPV vaccine and help reduce the rate of HPV-related cancers. You can do your part to help keep our members healthy for a lifetime. For more information about vaccinations for patients, including HPV, please visit the New York State DOH’s website.

Medicaid: New York State Medicaid Update

We are happy to share with you the newest issue of Medicaid Update (PDF), a monthly publication from the Office of Health Insurance Programs of the New York State Department of Health that offers guidance on policy and billing changes, and pharmacy reminders.

The June edition includes Medicaid coverage of limited infertility benefit; breastfeeding recommendations for women impacted by opioid use disorder and infants with neonatal abstinence syndrome; New York Medicaid EHR incentive program; policy clarification on medical marijuana and pharmacy fee-for-service billing guidance Long-Term Care and Foster Care (child care) facilities; and more. If you missed a previous issue, or just want to review their archive, please visit the DOH Medicaid Update page.

Review your directory information today

See video on how to make updates. If you are leaving a service location, please notify us as soon as possible so we can support you and your patients with appropriate transitions of care.


Medical Policy Updates

This month’s update includes revisions to the following medical policies: Medical Necessity Guidelines: Experimental, Investigational or Unproven Services, Noncoronary Vascular Stents, and Osteogenesis Stimulators.

Medical Technologies Database Updates

To see the latest updates, click here.


EmblemHealth updates its formulary on a regular basis. Find our most recent updates here


Required SNP MOC training coming soon

The annual training for Special Needs Plan (SNP) Model of Care (MOC) will launch soon. The training is required for providers who participate in the VIP Prime Network. Look for our notice to arrive via email, fax, and postal mail. The communication will include the user ID and PIN number needed for this required training.

New to EmblemHealth? Join us on August 14 for our monthly webinar for practitioners and office staff

This webinar provides an overview of our products and benefit plans, special utilization management programs, and how to navigate our provider portal. Sign up for our next webinar on August 14 at 10 to 11 a.m. or 2 to 3 p.m. Space is limited. Register today

Webinar: Revised Speech Generating Device Guidelines

According to the New York State Department of Health, the revised
Speech Generating Device (SGD) guidelines have been released. (See page 104.) A webinar is scheduled for August 15 at 10:00 am. Register today.

Free Educational Opportunities

Pri-Med Offers Free CME Activities
Choose from a growing list of online CME activities sponsored by Pri-Med. These activities address the latest research in multiple topic areas. Thoroughly examine a topic from all angles with five activity formats, including case studies, slide lectures and clinical reviews. You can manage your learning, track credits online, and complete activities at your own pace.

Provider Update
eNews Policy Update