JUNE 2012

National Coverage Determinations for Medicare Members

The Centers for Medicare and Medicaid Services (CMS) released National Coverage Determinations for new preventive services to be offered without cost-sharing. When a Medicare member sees a network provider, all of the services on the list must be covered with no member copayment. EmblemHealth is working to establish protocols to ensure that claims for the items or services outlined by the National Coverage Determinations are paid retroactively to the effective dates of these changes.

Medicaid Update

Low Birth-Weight Babies
Before April 1, 2012, our Medicaid contract with the New York State Department of Health excluded infants weighing less than 1,200 grams at birth, or who were disabled and under 6 months of age. As of April 1, 2012, these low birth-weight babies have coverage under our HIP Medicaid plans. more

Changes to Programs Administered by CareCore -- Effective October 1, 2012

CareCore currently administers radiology and cardiology programs on behalf of various EmblemHealth benefit plans. Beginning October 1, 2012, additional benefit plans will be included in these programs. A new utilization management program for Radiation Therapy will also be implemented on October 1, 2012. Mailings will be sent to providers directly affected by these changes. As we get closer to the start date, program details will be posted to our Web site and added to the EmblemHealth Provider Manual.

EmblemHealth Consolidates Post Office Boxes for GHI HMO

The following Kingston Post Office Box addresses currently in use for GHI HMO and EmblemHealth Medicare PPO Customer Service and Grievance and Appeals will be closed effective September 1, 2012. more