Pre-authorization list changes slated for August 1 for HIP Commercial & Medicaid members
Beginning August 1, 2019, for HIP’s Commercial and Medicaid lines of business, we will supplement our current utilization management pre-authorization list with 99 codes (27 current and 72 new) that have site-of-service rules. All other codes remain unchanged, and will continue to apply to all members. The site-of-service rules identify procedures that do not require a pre-authorization if performed in certain office settings (POS 11) or in an ambulatory surgery center (POS 24). To help you find our pre-authorization rules, we added a new section to Clinical Corner.
The same rules apply to all managing entities (HIP, Montefiore CMO, and HealthCare Partners) and delegates who conduct utilization management on our behalf.
Reminder: Medicaid Children’s Behavioral Health Services start July 1
Starting July 1, 2019, the EmblemHealth Enhanced Care plan covers more behavioral health services (community-based recovery-oriented services and supports) for children and youth. See our Appointment Availability Standards which have been updated to reflect these new services.
New contact information for LTSS for Medicaid and GHI PPO members
We have a new fax number and email address for you to request Long-Term Support Service (LTSS) for Medicaid members needing Personal Care Services, Consumer Directed Personal Assistance Services, Private Duty Nursing, Adult Day Health Care, and Personal Emergency Response Services. This also applies to GHI PPO members needing Private Duty Nursing. Please email: firstname.lastname@example.org or fax requests to: 212-510-5248. You may also use the email to send us your LTSS questions.
EmblemHealth opens Neighborhood Care location in Staten Island
EmblemHealth has opened a new Neighborhood Care center at 2655 Richmond Avenue in Staten Island. Learn more.
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.
Check PCP Panel Reports and schedule new patient visits
Primary care physicians: Please run PCP Panel Reports at emblemhealth.com/providers to identify new patients needing first visit outreach calls. Please encourage new Medicare and Dual Eligible Special Needs Plan (SNP) members to complete and submit their Health Risk Assessments.
CLAIMS CORNERThe Claims Corner section of our provider website is a rich resource of information that helps your practice navigate EmblemHealth claims and billing processes. See new Gastroenterology Policy.
PHARMACYEmblemHealth updates its Formulary on a regular basis. Find our most recent updates here.
Required SNP MOC training coming soonThe 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 July 10 for our monthly webinar for practitioners and office staffThis 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 July 10, 2019 10 to 11 a.m. or 2 to 3 p.m. Space is limited, Register today