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APRIL 2012
 Introducing Care360
EmblemHealth is pleased to announce Care360®, a new tool to order lab tests and obtain results from Quest Diagnostics, EmblemHealth's preferred lab for diagnostic testing. To get started, you may enroll at the "Care360" Web site. (Select Quest Diagnostics.) To use this feature once you're enrolled, sign in to www.emblemhealth.com and choose the "Lab Ordering/Results" link located on the left hand side of your home page. This link will direct you to Care360's Web site where you can order lab tests through Quest Diagnostics and receive lab results electronically, at any time. This service is free of charge.
Claims Corner
Discontinue Use of CPT Codes Retired January 1, 2012
Effective immediately, please discontinue use of CPT codes retired January 1, 2012, and use the alternate CPT codes assigned until further notice. more
Use of Occurrence Codes 40 and 41 for Pre-Surgical and
Pre-Admission Testing
As of March 1, 2012, occurrence codes 40 and 41 must be entered together on a claim submitted for pre-surgical and pre-admission testing. Both codes, which identify the length of time between the PST/PAT services and the admission or outpatient surgery, must be submitted on the claim for the claim to be processed correctly.
Independent Arrangements for the Provision and Payment of Noncovered Services
For services that require prior approval, (e.g., admission to a skilled nursing facility), for which the prior approval request is denied, the provider may only offer or render such noncovered services if the provider makes independent financial arrangements with the patient, including a signed agreement, before the specific service is provided.
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ICORE Webinar Schedule
Below is the schedule for the ICORE Webinar presentations instructing providers on how to obtain prior approvals for injectable medications via the ICORE Web site. Webinar registration begins on May 1, 2012.
ICORE Instructional
Webinar Dates |
| May 24 |
4 pm |
| May 30 |
4 pm |
| May 31 |
1 pm |
| June 1 |
1 pm |
| June 4 |
4 pm |
Provider Advisory Webinar
Join us for our next Provider Advisory Webinar giving an overview of EmblemHealth policies and procedures scheduled for Thursday, May 17, 2012, from 9 am to 10 am. Registration will begin on April 30, 2012.
Get Ready for ICD-10
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More News on Medicare and Medicaid Change
We will continue to keep you apprised of modifications to our Medicare and Medicaid plans in response to New York policy changes or recommendations from New York's Medicaid Redesign Team.
EmblemHealth Provides MLTC
New York has instituted policies that will affect recipients of both Medicare and Medicaid who need at-home benefits. Patients who receive over 120 days of at-home care need to choose and enroll in a Managed Long-Term Care (MLTC) plan before these changes are implemented. After 120 days, the State of New York will assign members to a  plan that may not be their first choice. This could mean different at-home care providers for your patients.
EmblemHealth has a Medicaid Advantage Plus MLTC plan that offers your patients quality HMO health care coverage along with at-home care at no extra charge. Or, they can choose the MLTC Partial Plan that solely provides at-home care.
New York State Health Home Program Has Begun
As of March 1, 2012, Medicaid and Family Health Plus (FHPlus) members with chronic illnesses may be eligible for New York State's Health Home program in both Medicaid Fee-For-Service and Managed Care plans. These members are being invited to participate in designated Provider-Led Health Home (PLHH) services in their county of residence. New York developed these PLHH services under the federal Patient Protection and Affordable Care Act (PPACA). more
Training for Our Injectable Drug Utilization Management Program
Beginning June 1, 2012, EmblemHealth will collaborate with ICORE Healthcare, LLC to provide utilization management (UM) for specific injectable drugs, which will require prior approval from ICORE for certain members. ICORE will be offering Webinars to introduce practitioners to their Web site and provide instruction on how to request prior approvals for the injectable drugs on the list. Registration for these Webinars will begin May 1, 2012.
New Business
We are initiating a new feature in our monthly Policy Updates. We will inform you of new companies and organizations who have selected an EmblemHealth, GHI or HIP insurance plan for their employees. These new groups may have an impact on the EmblemHealth members you see from your area.
| Organization |
Effective Date |
Area |
Plan |
Church Avenue Merchant and
Business Association |
May 1, 2012 |
Flatbush, Brooklyn |
EmblemHealth EPO/PPO
GHI PPO |
Ridgewood-Bushwick
Senior Citizens Council |
April 1, 2012 |
Border of Queens
and Brooklyn |
In-Balance EPO with
vision and dental riders
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Chinese American
Planning Council |
March 1, 2012 |
Manhattan |
EmblemHealth EPO |
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City Health Information Goes Electronic
For 30 years The New York City Department of Health and Mental Hygiene has distributed a bulletin to the medical community, City Health Information (CHI). Starting in April 2012, the bulletin begins electronic distribution. We encourage you to subscribe to receive CHI electronically. more
HEDIS 2012 Continues
Our annual Healthcare Effectiveness Data and Information Set (HEDIS®) audit began in February and continues through May 2012. HEDIS results are an integral part of the National Committee for Quality Assurance (NCQA) accreditation process and are a reflection of the quality of care that our members receive in your offices.
How You Can Help
If you are asked to submit medical records, please ensure that you follow the standards set by NCQA and by the New York State Department of Health, and that the records are submitted within the requested time frames.
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Update Your Information
Please keep your provider information current by going to www.emblemhealth.com.
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©2012 EmblemHealth. All Rights Reserved. .
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Group Health Incorporated (GHI), GHI HMO Select, Inc. (GHI HMO), HIP Health Plan of New York (HIP), HIP Insurance Company of New York and EmblemHealth Services Company, LLC are EmblemHealth companies. EmblemHealth Services Company, LLC provides administrative services to the EmblemHealth companies.
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