Posted in EmblemHealth NY, NY Providers, Training, Updates

EmblemHealth/Connecticare: Telehealth Reimbursement Policy Update for 2022

If you are a provider that accepts patients with EmblemHealth and/or Connecticare Insurance this blog post is for you!

This policy applies to Emblemhealth/Connecticare Commercial, Medicare and Medicaid Members.


Effective 01/01/2022- EmblemHealth/Connecticare has updated their telehealth policy. The following update was added:


Effective 06/01/2022- changes effect modifiers:

Want to learn more? Please click here to see the whole telehealth policy.


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Posted in EmblemHealth NY, NY Providers, Training, Updates

EmblemHealth NY Medicaid and HARP members: Non-Invasive Prenatal Trisomy Screening Expanded!

Effective 11/01/2021 coverage of non-invasive prenatal trisomy screening using cell-free fetal DNA (deoxyribonucleic acid) has been expanded to include pregnant members age 30 and older.

This benefit also will include twin pregnancies, but not higher multi-gestational pregnancies


Consistent with current policy, non-invasive prenatal trisomy screening will continue to be covered when at least one of the following criteria is met:

  • Either parent has a family history of aneuploidy in a first* or second** degree relative.
  • Standard serum screening or fetal ultrasonographic findings indicate an increased risk of aneuploidy.
  • Parent(s) have a history of a previous pregnancy with a trisomy.
  • Either parent is known to have a Robertsonian translocation.

Definitions:

*First degree relatives: Parents, children, siblings
** Second degree relatives: Grandparents, aunts and uncles, nieces and nephews, and grandchildren


Note: This is an update to the October 2014 Medicaid Update article titled NYS Medicaid Now Covers Non-invasive Prenatal Testing for Trisomy 21, 18 and 13.

You can find the updated version of this policy (NY Medicaid) here.  


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Posted in MVP (NY/VT) Insurance Payer, NY Providers, Training, Updates

MVP NY Medicaid Plans: Medical Devices and Supplies coverage change

This policy applies to MVP NY Medicaid Plans and their coverage for Medical Devices and Supplies.

The following examples are not all inclusive, that apply to this policy:

  1. Foot Care products: insoles, massagers, arch supports
  2. Pill Splitters
  3. Body weight scales
  4. Pulse Oximeters
  5. Thermometer’s (only oral, rectal and basal are covered)
  6. Wheelchair products
  7. Medical fridges
  8. Commodes
  9. Transfer benches
  10. Safety rails (bed, wall, bath)
  11. Fetal dopplers
  12. Bath/shower/toilet sears
  13. Sharp’s containers
  14. Ear Plugs
  15. Nasal dilator strips
  16. Cushions
  17. Decompression belts
  18. Reaches
  19. Travel Coolers etc
Picture Via Cumberland ME

MVP is aligning with NY Medicaid Fee for Services DME coverage. Devices or supplies that are NOT COVERED under FFS Medicaid “Pharmacy Fee Schedule” will continue to not be covered. Applicable DME Products should be billed under the member’s DME Benefit.


For complete list of NY MEDICAID DME COVERED and NON-COVERED Products, please click here.


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