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Here are the top 10 new and updated resources to help you manage your EmblemHealth and ConnectiCare members in 2022:
- EmblemHealth 2021-2022 Annual Provider Notice details important changes for 2022, summarizes changes introduced in 2021, highlights key training and regulatory requirements, and shares helpful resources.
- Provider Portal videos and guides for EmblemHealth and ConnectiCare
- 2022 Summary of Companies, Lines of Business, Networks & Benefit Plans lets you know which networks and benefit plans fall under each of our companies’ provider agreements. This summary also tells you which plans require primary care providers and/or have referral requirements, out-of-network coverage, annual maximum out-of-pocket limits, and copays.
- New dedicated EmblemHealth and ConnectiCare Medicare Advantage webpages
- New EmblemHealth Commercial Plans webpage
- Updated Bridge Program webpage
- Updated sample EmblemHealth Member ID Cards
- New EmblemHealth Case/Care Management program library; also learn about ConnectiCare’s Care Management Programs
- New Enterprise Pharmacy Medical Policies webpage
- New EmblemHealth Formularies webpage
The EmblemHealth Access & Availability Requirements has not changed but is always helpful.
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. Registration link: https://bit.ly/2Y9DrBj.
For more information about this plan, including an informative Frequently Asked Questions (FAQ), please visit our dedicated NYC Medicare Advantage Plus Plan page.
More than 13,000 women in the United States are diagnosed with invasive cervical cancer each year. The good news is the disease is preventable with vaccination and appropriate screening.
January is Cervical Cancer Awareness Month. We encourage you to talk to your patients about Pap tests, HPV tests, and related vaccines.
The CDC recommends all boys and girls get the HPV vaccine at age 11 or 12 as the vaccine produces a stronger immune response when taken during the preteen years. For this reason, up until age 14, only two doses are the vaccine are required. Be sure to have the HPV vaccine series completed by age 13 to ensure gap closures for HEDIS. Proactive scheduling and call campaigns are often most effective for this measure.
In February, we take time to recognize and reflect on the conditions, diseases, and habits that impact the heart. For more information on lifestyle choices and other ways to prevent and combat heart disease, leading to a long, healthy life for both you and your patients visit the CDC website.
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