Tag: #empire

Posted in Insurance, Updates

New York Providers: Empire non-covered services for Managed Medicaid Care

Posted on by KR2Medical Billing

NOTE: This announcement was published in Empire NY Providers communication section on FEB 1,2020

According to Empire BCBS Health Plus (NY)- starting back in 12/1/2019- they began denying claims that were billed with non-covered codes (NY Medicaid).

HCPCS and CPT codes that are not on the NY Medicaid fee schedule are considered non-covered.

This policy affects only MMC and Child Health Plus programs.

Empire suggests that some of these non covered codes should be billed with a more appropriate code or a code that is considered (bundled).

For the list of COVERED codes please click on https://www.emedny.org.

For a complete list of NON covered CPT/HCPCS codes please visit: https://mediproviders.empireblue.com/ProviderUpdates/NYNY_CAID_PU_NoncoveredCPTHCPCSCodes.pdf

Providers should bill the most current CPT or HCPCS code on the current NY Fee Schedule to avoid unnecessary denials.

If you have questions about this announcement please contact your Provider Relations Representative or the Provider Services: 1-800-450-8753

Posted in Insurance, Updates

Reminder for NY Providers: Partnership between Empire BCBS and Montefiore ACO IPA &Montefiore Care Managment Ended on 12/31/2019

Posted on by KR2Medical Billing

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?

A3:

  1. 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
  2. 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
  3. 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.
  4. 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

Posted in Insurance, My services, Training, Updates

Anthem BCBS acquires Beacon Health Options

Posted on by KR2Medical Billing

As of March 01/2020- Anthem BCBS finalized its acquisition of an independent behavioral health organization, Beacon Health Options.

Beacon Health Options serves over 36 million people across the country.

Things to consider:

  1. Members- can still use the phone number on the back of the cards and their health plan’s website to access self-services.
  2. Providers- continue using the provider service contact information on the back of the member’s card or online self-service portals or websites

According to the announcement the Beacon Health and Anthem provider networks, contracts and fees will remain separate at this time.

For full announcement please visit: https://providernews.empireblue.com/article/anthem-acquires-beacon-health-options

As well Anthem announcement to the investors: https://ir.antheminc.com/news-releases/news-release-details/anthem-inc-completes-acquisition-beacon-health-options?field_nir_news_date_value%5bmin%5d=