Tag: #empire

Posted in #unitedhealthcare, NY Providers, Payer Updates, Updates

UHC: Empire Plan- new cards

Posted on by KR2Medical Billing

As per UHC – members that have Empire NYSHIP plan and/or Student Employee Health Plan will have their cards updated for 2025.

Below please find the new design of the cards.

Source via UHC website
Source: via UHC website
Source via UHC website

So what do you think? Are they better than the old blue cards?

Find this information useful? Follow my blog for payer updates, medical billing and coding guidelines.

Posted in #reimbursement, #unitedhealthcare, NY Providers, Updates

UHC: Empire Plan updates

Posted on by KR2Medical Billing

If you are a provider that accepts UHC Empire Plan in NY or a patient that has Empire plan then there are several important things that you should take notice of.

  1. Out of network allowed amounts: according to UHC- the reimbursement for OON providers is based on Medicare rates.
  2. Out of network acupuncture services: no matter how many providers that the member visits the maximum # of allowed visits is 20 per calendar year
  3. In network massage therapy services: only 20 visits are covered, per calendar year.
  4. Empire Plan mental health program that is administered by the Carelon Behavioral Health partnered with Hazelden Betty Ford Foundation to provide substance abuse services to the Empire plan members at no cost. Outpatient services are available in California, Florida, Illinois, Minnesota, New York, Oregon and Washington. Prior authorization is required.

If you find this type of information useful? Follow my blog for more up to date medical billing, coding, reimbursement and healthcare trends.

Posted in BCBS Empire NY, Training, Updates

BCBS NY Medicaid: New Policy-Pass-through and Outside Laboratory billing

Posted on by KR2Medical Billing

This reimbursement policy applies to Empire BCBS Health Plus members. The new reimbursement policy will become effective for DOS on 10/01/2021 and thereafter.

Empire BlueCross BlueShield HealthPlus does not allow pass-through billing for lab services. Claims appended with Modifier 90 and an office place of service will be denied unless provider, state, federal or CMS contracts and/or requirements indicate otherwise.

Reimbursement:

Empire BCBS HealthPlus will reimburse 100% of the applicable fee schedule or contracted/negotiated rate to the diagnostic laboratory that is performing the test.

Coding: Modifier 90-definition

Modifier 90 is used when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified healthcare professional. The procedure may be identified by adding Modifier 90 to the usual procedure number.

To read the complete reimbursement policy, please click here.

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