Category: NY Providers

Find Medical Billing and Coding guidance for any Providers that operate in NY State

Posted in MVP (NY/VT) Insurance Payer, NY Medicaid EHR incentive program, NY Providers, Payers and CPT reinbursement, Updates

MVP postpartum program incentive payments: NY providers!

Posted on by KR2Medical Billing

Are you any of these following providers in NY?

OB/GYN Family Medicine Certified Nurse Mid-wives Nurse Practitioner – Family Health

Then this blog post is for you!

NY DOH established an additional payment (to global OBGYN bundled payment) for providers that complete a person-centered postpartum visit— including a depression screening—within 12 weeks of delivery, as per ACOG/AAP guidelines.

In order to qualify for this additional payment the postpartum services need to be related to deliveries that occurred from July 1, 2024, through March 31, 2025.

Coding that qualify for this program are:CPT II Code 59430 or 0503F

Please bill these codes with $0

This program only applies to Managed Medicaid Care Plan type.

The additional payment amount is $125.

The payments are maid quaterly basis.

Find this type of information useful? Follow my blog!

Posted in #reimbursement, BCBS (Various States), BCBS Empire NY, NY Providers, Pharmacy (Various Insurance Payers)

BcBS HighMark NY: coverage for COVID-19 vaccine

Posted on by KR2Medical Billing

According to Highmark BCBS- the COVID-19 vaccine will be covered with out any pocket costs through 2025-2026.

This currently only applies to Managed Medicaid, Child Health Plus, Essential and HARP plan types.

The vaccine will still be part of standard preventive care benefits, COVID‑19 vaccines are covered for all members older than 6 months of age.

Members are encouraged to contact their primary care or pharmacy for vaccine availability.

Highmark will partner with Wellpoint companies to administer this benefit.

As per Highmark-Wellpoint Insurance Services, an independent company, administers utilization management services for Highmark Blue Cross Blue Shield’s managed Medicaid.
Wellpoint Partnership Plan, LLC provides management services for Highmark Blue Cross Blue Shield’s managed Medicaid.

Certain sef-insured plans have special vaccine coverage and should check their benefits coverage for more info.

Find this type of information useful? Follow my blog for more!

Posted in #reimbursement, EmblemHealth NY, NY Providers, Payer Updates, Training, Updates

EmblemHealth/Connecticare/Molina Health update

Posted on by KR2Medical Billing

Are you a provider in CT or NY that serves EmblemHealth/Connecticare members-this blog post is for you!!!

Back in July of 2024, EmblemHealth announced and entered into an agreement with MolinaHealth to sell ConnectiCare (a company part of EmblemHealth).

In a Feb 2025, the sale was finalized.

So what does this mean to you as a provider?

EmblemHealth put together a reference table that the providers can utilize to check the plan/network information and which area that plan/network covers, plus description of the plans; ex deductible, copay, OON benefits, etc.

Image via EmblemHealth website.

Please visit here to view the PDF version of the whole document.

Molina also created a FAQs section that you can access from the same EmblemHealth website.

Find this type of content useful? Subscribe to my blog for most current healthcare payer news.