Here Comes HEDIS 2012
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.
New Injectable Drug Utilization Management Program Begins
Beginning June 1, 2012, EmblemHealth will collaborate with ICORE Healthcare, LLC to provide utilization management (UM) for certain injectable drugs, which will require prior approval from ICORE. Practitioners who participate in the separate ICORE specialty pharmacy program may continue to obtain drugs through the program, but prior approval will be required before the drug is ordered. more
Instructional Webinars -- Save the Dates
ICORE will be offering Webinars closer to the implementation date. These Webinars will introduce practitioners to their Web site and will provide guidance on how to request prior approval. More information will follow.
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.
SBIRT Credentialing Process
In September 2011, we informed practitioners that the Screening, Brief Intervention and Referral to Treatment (SBIRT) policy for Medicaid managed care and Family Health Plus members expanded to include certified primary care physicians. In response to this modification, EmblemHealth is credentialing practitioners for SBIRT services as part of our credentialing/recredentialing process. more