Tag: #NYmedicaid

Posted in Insurance, Payer Updates, Training, Updates

BCBS NY Medicaid: Ocrevus/Vyepti Medical Step Therapy Notice

Posted on by KR2Medical Billing

Starting for DOS on 04/01/2021 and thereafter, the following medications will be added to BCBS NY Medicaid Step Therapy.

Step therapy review applies upon precertification initiation or renewal in addition to the current medical necessity review.

To see the full clinical criteria/medical policy for Ocrevus, please click here.

To see the full clinical criteria/medical policy for Eptinezumab, please click here.

Posted in NY Medicaid EHR incentive program, Training, Updates

Successful NY Medicaid EHR Incentive Program: Meaningful Use Audit

Posted on by KR2Medical Billing

I am proud to say that after 2 months of working on this project, my client successfully passed an audit for NY Medicaid EHR Incentive Program: Meaningful Use for the year ending 2017

What a fantastic way to start the year!

Summation Letter. Successful Meaningful Use Audit passed!

If you would like to see more of my past or current/coming up projects, please visit my Project Portfolio Page

Posted in Insurance, Training, Updates

EmblemHealth (NY) COVID-19 Vaccine and Monoclonal Antibody Infusions Policy

Posted on by KR2Medical Billing

Effective 11/09/2020 the following are the guidelines for COVID-19 Vaccine and Monoclonal Antibody Infusions for various EmblemHealth Product lines:

  1. Commercial Plans- EmblemHealth will cover the costs that are associated with administration of COVID-19 vaccines, for In-Network and Out-of-network providers, during the national public health emergency period. Reimbursement will be based on CMS published rates. NY state-specific rules may also apply: Please click here for a NY DOH COVID-19 vaccine presentation.
  2. Medicare Advantage Plans- charges for administrating the COVID-19 vaccine should be billed to your local MAC (Part B). The MAC will reimburse claims for Medicare members with no cost share for the remainder of 2020 and through 2021 If the provider will bill the claims to EmblemHealth the charges will be denied and the provider will be informed that the charges need to be submitted to the local Part B MAC. (If you are a provider located in NY the local Part B MAC is NGS- national government services).
  3. Medicaid Plans- EmblemHealth will cover costs that are associated with administration of COVID-19 vaccines, for In-Network and Out-of-network providers, during the national public health emergency period. NY state-specific rules may also apply: Please click here for a NY DOH COVID-19 vaccine presentation.

Partial List applicable to this reimbursement policy:

For the complete policy and the complete list of applicable codes, please click here to visit the policy.