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The Centers for Medicare & Medicaid Services (CMS) requires hospitals, including critical access hospitals (CAHs), to give written and verbal notice of receiving outpatient observation services of more than 24 hours to Medicare beneficiaries, including Medicare Advantage enrollees. All hospitals and CAHs must use the updated version of the Medicare Outpatient Observation Notice (MOON) (CMS-10611) no later than April 27, 2023. The notice is available for download.

The following preauthorization lists have been updated to remove codes effective April 1, 2023:

EmblemHealth – See Notable Changes for the 149 codes removed from the list. Also see CPT 76948, “Ultrasonic guidance for aspiration of ova, imaging supervision, and interpretation,” being added to the list starting July 14, 2023.

ConnectiCare Commercial – See revision history for the 137 codes being removed.

ConnectiCare Medicare – See revision history for the 116 codes being removed.

Beacon Health Options has been renamed to Carelon Behavioral Health. Their new website is carelonbehavioralhealth.com but nothing changes about our members’ access to care. Please review the EmblemHealth Provider Manual’s Behavioral Health chapter if you need a refresher on what’s offered and how to connect to these services.

The following medical policies have been revised for both EmblemHealth and ConnectiCare:

• Bariatric Surgery — Added pediatric criteria. (EmblemHealth | ConnectiCare).
• Infertility Services  — Added non-coverage of uterine transplant for the treatment of uterine factor infertility to the list of Limitations/Exclusions. Added clarifying edits to “General indications,” “General infertility surgery,” and “Noncovered services.” (EmblemHealth | ConnectiCare).
• Osteochondral Grafting — Added patellar chondral defect indication to coincide with covered diagnostic coding. (EmblemHealth | ConnectiCare).
• Rhinoplasty — Removed the photo documentation prerequisite. (EmblemHealth | ConnectiCare).

The following EmblemHealth medical policies are being retired:

• Genetic Counseling and Testing.
• Outpatient Cardiac Rehabilitation.
• Supervised Exercise Therapy for Symptomatic Peripheral Artery Disease.

If you need help navigating our provider portals, our videos, quick guides, and frequently asked questions (FAQs) pages can help.

In the last edition, we announced that the attachment file size for supporting documentation file uploads in the provider portal increased to 25MB. This applies to preauthorizations only at this time. The size for all other transactions is 5MB. We will provide an update as soon as it becomes available.

EmblemHealth Videos and Guides

EmblemHealth FAQs

ConnectiCare Videos and Guides

ConnectiCare FAQs

Contact Provider Customer Service if you still have questions or need additional support:

EmblemHealth: 866-447-9717

ConnectiCare: Commercial: 860-674-5850, Medicare: 877-224-8230

EmblemHealth works with Veradigm to offer free monthly webinars to help educate providers on best practices regarding the risk adjustment process. This includes accurate medical record documentation and claims coding to capture the complete health status of each patient. 

EmblemHealth also works with Veradigm to promote risk adjustment and gap-closure education for primary care providers (PCPs) caring for EmblemHealth members enrolled in these products:

• New York State of Health (NYSOH) Marketplace.
• Medicare HMO.
• Medicaid.

The Veradigm webinars are held on Tuesdays and Thursdays, with one session in the morning and one in the afternoon to accommodate all schedules. Here are the April and May topics:

• April 25 and 27 – Don’t Be Fooled … Social Determinants of Health are Key Factors for Your Patient Population*
• May 23 and 25 – Blooming into the Comprehensive Evaluation of Neurological Disorders

To register, go to our Online Learning > Veradigm Webinars web page to scan topics and dates. Click the Registration button at the bottom, then the Public Event List link and search by webinar date or title of interest.

If you have any questions, or you would like to set up a private session for your practice, email Veradigm at providerengagement@veradigm.com or call Veradigm's Customer Support team at 410-928-4218 (option 7), available Monday through Friday from 8 a.m. to 8 p.m.

*You can also see our own medical director’s perspective on population health and the social determinants of health.

We recommend that you take advantage of the training opportunities offered by CMS’s Medicare Learning Network and eMedNY.