Effective 01/01/2020- for dates on or after 01/01/2020-when NYSHIP Empire patients will get immunization services in outpatient Hospital (POS 22), Empire BCBS will consider these claims.
BEFORE 01/01/2020-claims need to be submitted to UHC, NYSHIP-s medical benefit administrator
Please remember all claims are subject to standard medical necessity guidelines and contract limitations.
New* For 2020-UnitedHealthCare announced that Oxford (Commercial Plan) members will start to receive new benefit cards. There will be several changes.
These changes as follows:
The Payer ID will NOT CHANGE it will remain as 06111
*You will be able to use the UHCprovider.com for secure member transactions, including checking eligibility, benefits and claims.
Do you see NY Empire State Plan patients? Have you noticed something different in your payments for the year 2019?
If not, then do not fret. Here is what is new for the year 2019
In 2019- reimbursement for CPT code 94200 is $0 with a patient responsibility of a co-pay of $25.
Yes, now the patient has to pay for the whole “allowed amount”!
Also the co-pay for the E/M codes also went up to $25 for certain plans. You will need to look up the benefits before the appointment.
Compare to 2018- reimbursement for CPT code 94200 was $5 with a co-pay of $20.
KR2 Medical Billing 