OFFICE VISIT

We are committed to making it easier and more intuitive to work with our health plan by continually investing in improvements to our technology, especially our provider portals. Here are the newest portal updates we hope you will find helpful:

You now have a “Back Button” in the Claims, Referral, Preauthorization, and Eligibility details pages that returns you to the search results screen so you do not need to restart the transaction if you need to confirm or change something on the previous screen.

In the Provider Profile, we have added indicators for when a provider falls under a delegated credentialing arrangement and cannot submit demographic updates through our portals. When “Delegated” appears on a row in the Locations Table, you need to report your changes to your delegated group’s administrator who will share those changes with us through an established special process. Please take advantage of the provider portal’s ability to upload documents in support of your preauthorization requests, concurrent reviews, and discharge plans.

Given the rapid changes to COVID-19 coverage rules, we ask that you review the information we are sharing with your patients about when they need to get tested, what is covered, and their convenient options for testing.

EmblemHealth | ConnectiCare

February is Children’s Dental Health Month and a good time to talk to your patients—both children and adults – about the importance of regular dental visits. Preventable dental diseases—such as gingivitis, tooth abscess, and gum disease—are among the most common health conditions affecting a person’s health. Poor oral health is also linked to an increased risk of serious health conditions and chronic diseases that put added strain on the health care system, particularly the Emergency Department.

Primary care providers play a major role in the overall health of their patients and can influence their decision to see a dentist before it becomes an emergency. Encourage your patients to make dental appointments part of their annual wellness checkups. Promoting dental health is key to overall health and can have a significant impact on your patients.

In recognition of Colorectal Cancer Awareness Month, we want to emphasize the importance of educating patients about colorectal cancer screening, prevention, and treatment. You can also encourage patients who have been diagnosed with colon cancer, survivors, and even caregivers to share their stories with others to further promote awareness.

Here are a few resources you can use to help spread the word about colorectal cancer screening and prevention:

• Colorectal Cancer Screening: Patient Version (NIH)
• Colorectal Cancer Screenings Tests (CDC)
• Colorectal Cancer Screening Patient Poster (American Society for Gastrointestinal Endoscopy)
• Resources for National Colorectal Cancer Awareness (American Society for Gastrointestinal Endoscopy)

We want to update you regarding the new April 1, 2022 effective date for the NYC Medicare Advantage Plus offering for The City of New York retirees.

On April 1, more than 200,000 Medicare-eligible City of New York retirees will transition to the NYC Medicare Advantage Plus Plan offered by an alliance between Empire BlueCross BlueShield (Empire) and EmblemHealth.

The NYC Medicare Advantage Plus Plan is a Medicare Advantage PPO 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. 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.

The NYC Medicare Advantage Plus Plan offers the same hospital and medical benefits that Original Medicare covers, as well as additional benefits that Original Medicare does not provide, such as an annual routine physical exam, hearing exams, health and fitness tracking, LiveHealth Online, and SilverSneakers®.

Are you in-network? If you are contracted with any of the following networks, you are already an in-network provider participating in this plan. You should continue to see your City of New York retiree patients and submit claims to Empire or your local BlueCross BlueShield plan:

• EmblemHealth’s Medicare Choice PPO
• Empire MediBlue PPO
• BlueCross BlueShield (BCBS) Medicare Advantage PPO Network

Are you out-of-network? No problem. You can see City of New York retirees and will still get paid 100% of the Medicare-Allowed rate. No contract required.

• You can continue seeing our members as long as you are eligible to receive payments from Medicare.
• Your reimbursement is the same as under Original Medicare.
• Our members are not required to obtain a referral before they see a provider.

Please take advantage of our upcoming provider webinar to help you better understand these upcoming changes. Register here.

For more information about this plan, including an informative Frequently Asked Questions (FAQ), please visit our dedicated NYC Medicare Advantage Plus Plan page.