Medicare and Medicaid Updates

In this issue we update you on Screening, Brief Intervention and Referral to Treatment credentialing requirements, EmblemHealth’s Managed Long-Term Care Program and the New York State Provider-Led Health Home Program and new policies regarding medical supplies for Medicaid members. more

Introducing Care 360

We are announcing a new method to order lab tests and get the results electronically from Quest Diagnostics. You may enroll by using the link in the article. more

EmblemHealth Injectable Drug Utilization Management Program Begins

This new drug utilization management program begins on June 1, 2012, in collaboration with ICORE. ICORE is offering Webinar trainings for affected providers on the process for obtaining required prior approvals for the injectable drugs associated with this program. more

Medical Director Availability After an Adverse Determination

Medical directors evaluate requests for procedures and services using evidence-based criteria and guidelines to make their determinations. If a medical director makes an adverse determination, you have avenues for appeal. Medical directors are available to discuss their decisions. more

Colorectal Cancer Screening

Discussing and promoting colorectal screenings are an important way to reduce the number of deaths from colorectal cancer. EmblemHealth, New York State and most insurance plans cover these screenings. more

Additional Articles:

Claims Corner

Utilization Review Criteria Update

Member Rights and Responsibilities

Provider Advisory Webinars a Success

CAHPS Member Satisfaction Surveys Are in the Field!

Medication Adherence for Chronic Conditions

Medical Management of COPD

Dental Hygiene Is Important

How to Help Your Patient With ADHD

Your Role in Slowing the Obesity Epidemic

Health and Wellness Programs

What Is a Health Outcome Survey?

Clinical Corner