Starting 01/01/2020 Empire BCBS will re-assume certain administrative functions from Montefiore CMO.
The following are the questions and answers related to this announcement:
Q1: Which Plans will be affected?
A1: Empire-Managed Medicaid Plan, Child HealthPlus, Essential Plan, and HARP, who are assigned a PCP that belongs to the Montefiore IPA
Q2: What about the providers that are part of the Montefiore Medical Center?
A2: These providers and Empire members will continue to participate with Empire under the traditional fee-for-service agreement
Q3: Which Administrative functions will Empire re-assume?
- Prior authorization for elective service that are going to be performed on 1/1/2020 and after-Prior authorization requests can be requested electronically via Availity or by phone: 1-800-964-3627
- Medical Management- as a provider you can obtain prior authorization, or verify patients eligibility and benefits by calling the phone number listed on the back of the patients card
- Claims Processing- IPA providers will NO LONGER SUBMIT THEIR CLAIMS TO MONTEFIORE CMO, instead they will need to submit them to Empire directly. NON-IPA participating providers will have to continue to submit their claims directly to Empire.
- Credentialing Process- IPA participating providers- Montefiore CMO will continue to handle all of the credentialing for its IPA participating providers. NON-IPA participating providers- must continue to follow Empire Process
Q4. If I still have questions, who can I contact?
A4: Empire Provider Services: 18800-450-8753
Q5. If I am a Montefiore IPA Participating provider and have questions regarding my participation in Empire network, who can I contact?
A5: Empire Network Services: 1-888-666-8326