Tag: #Emblemhealth

Posted in EmblemHealth NY, NY Providers, Training, Updates

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

Posted on by KR2Medical Billing

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 Insurance, Training, Updates

EmblemHealth (NY)-Care Management Program for Kidney Patients, 05/01/21

Posted on by KR2Medical Billing

Starting 05/01/21- EmblemHealth (NY) will offer the EmblemHealth Chronic Kidney Disease (CKD)/End Stage Renal Disease (ESRD) program.

What will this mean for your patients?

  1. EmblemHealth team of care managers, social workers, and pharmacists may be in touch with the physician’s office as they coordinate patient care.
  2. EmblemHealth is going to manage members affected by kidney disease

What will the EmblemHealth CKD/ESRD program do?

  1. The CKD/ESRD program will provide eligible members with holistic, seamless and, clinically robust wrap around support throughout all stages of their health care journey

What is the purpose of EmblemHealth CKD/ESRD Care Management Program?

  1. EmblemHealth’s CKD/ESRD program aims to slow the progression of illness and reduce unnecessary utilization. The program seeks to improve condition management and navigation of the healthcare system through a structured approach to person-centered assessment, care planning, and delivery of interventions.

Who will select the patents?

  1. EmblemHealth will identify members with complex needs and provide them with individualized care management interventions.

How to get in touch with EmblemHealth CKD/ESRD Care Management Program Staff?

  1. For more information or to make a referral, call us as at 800-447-0768, Monday through Friday, 9 a.m. to 5 p.m.
Posted in Insurance, Training, Updates

EmblemHealth (NY) E&M codes reimbursement policy: updated for 2021

Posted on by KR2Medical Billing

With the changes to the E&M codes, for the year 2021, EmblemHealth updated their reimbursement policy for providers.

The following is now the guidelines/reminder for E&M Reimbursement: documentation requirements

• The CPT® coding guideline updates only apply to 99202-99215.
– Other codes within the evaluation and management section of the CPT book are still subject to previous reimbursement policies.
• Chief complaint (Reason for visit) must be clearly documented.
• A clinically appropriate history and exam are still required.
• Medical Necessity, Medical Decision Making and Assessment & Plan are required to be
documented.
• When time is the determining factor for code selection, all start and stop times must be documented to substantiate total time on the date of the encounter.