There are no updates for Radiation Oncology Program Codes.
The following codes will be added to EviCore Prior Auth list, effective 03/01/2021.
MVP NY Update: more codes are added to eviCore prior auth list-03/01/21
Tag: #priorauthorizations
Reminder for NY Providers: Partnership between Empire BCBS and Montefiore ACO IPA &Montefiore Care Managment Ended on 12/31/2019
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:
- 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
- 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
- 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.
- 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
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Medicare Advantage Plans (Montefiore CMO) changes, starting 01/01/2020-NY providers/members, EmblemHealth
If you are participating provider in Motefiore IPA, then recently your office received a notice, regarding Montefore CMO Medicare Advantage Plan members.
Below are the outlined changes that will affect the members and your office, starting 01/01/2020
What is NOT CHANGING:
- Medicare VIP Prime Network
- EmblemHealth will not change the PCP assignments (for the members)
- Montefiore IPA contract between the provider and Montefiore will remain in effect.
- CMO will provide Management Services for all other EmblemHealth members except Medicare
What is CHANGING:
- Referrals- if the referring provider (PCP) is not part of Montefiore IPA, referral is required. PCP’s are encouraged to order the referral, while the patient is still in the office. (The referrals between Montefiore Providers will follow the same workflow as they do today-NO REF is REQ unless is for a specific procedure that does).
- Pre-authorizations- EmblemHealth will honor the prior authorizations that were issued by CMO. However, if the patient was seen after the date 01/01/2020 and needs a prior authorization, the provider needs to request it through EmblemHealth website, for non-delegated services. EmblemHealth will be releasing a new prior-authorization list on effective 01/01/2020. This list is available on emblemhealth.com/providers website. Beacon Health Options is responsible for behavioral health services. Beacon Health Options phone number is 1-888-447-2526.
- Submission of Claims- For dates of service that were done on 01/01/2020 and after the providers need to submit the claims directly to EmblemHealth. Providers please sent the claims to CMO, for the dates of service up to and including 12/31/2019. If the patient is admitted to an inpatient facility and is still in the same place of service in 2020, the claims should be submitted to CMO. Discharge planning, will be managed by EmblemHealth in coordination with eviCore if skilled nursing, inpatient rehab, home health care, or durable equipment is needed.
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