News & Announcements

Patient cost-sharing for laboratory tests to diagnose COVID-19, provider visits to diagnose COVID-19 and all telehealth services

Please be advised that the New York State Department of Financial Services (DFS), the New York State Department of Health (DOH) and the federal government are directing payers to waive patient copayments, coinsurance and deductibles for certain testing and treatment due to the COVID-19 emergency.

Empire BlueCross BlueShield suspends certain authorization requirements to aid COVID-19 response

The New York Department of Financial Services (DFS) has issued a Circular Letter dated March 20, asking all insurers to suspend certain utilization management review and notification requirements to free up staff for clinical support. Effective March 20, Empire has implemented the following for individual, employer-based fully-insured and self-insured (ASO), Medicare* and Medicaid plans.

COVID-19 update: Guidance for telehealth/telephonic care for behavioral health services

Anthem is closely monitoring COVID-19 developments and what it means for our customers and our health care provider partners. Our clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention (CDC) to help us determine what action is necessary on our part. We have made changes to how behavioral health providers can use and be compensated for telehealth (audio + video) and telephonic-only care with their patients.

COVID-19 information from Empire BlueCross BlueShield HealthPlus (Updated April 1, 2020)

We will update FAQs as more information becomes available. Providers should visit the News and Announcements of the provider website for the latest information from Empire about COVID-19.

SOMOS management of delegated functions postponed

The collaborative partnership between Empire BlueCross BlueShield HealthPlus (Empire) and SOMOS IPA, LLC (SOMOS) and its affiliates previously set for March 1, 2020, has been postponed until further notice.

SOMOS to manage delegated functions effective March 1, 2020

We are pleased to announce that Empire BlueCross BlueShield HealthPlus (Empire) has expanded its collaborative partnership with SOMOS IPA, LLC and its affiliates (SOMOS). This new agreement aligns incentives between the plan and SOMOS to deliver the highest possible quality care to our Medicaid Managed Care (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHPlus) and Essential Plan members in New York.

Availity Provider FAQ and Availity Notification

Starting March 9, 2020, Empire will launch the use of Availity’s Medical Attachment functionality for electronic communications. This new functionality allows providers to upload medical records and itemized bill information electronically instead of through traditional paper communications. This functionality can improve communications for medical record requests and receipt and will not impact the audit program.

Montefiore ACO IPA and Montefiore Care Management

Effective December 31, 2019, the provider collaboration partnership with Montefiore ACO IPA and Montefiore Care Management (CMO) will dissolve.

Acute care general hospital inpatient medical or surgical room and board

The purpose of this communication is to provide guidance on the reimbursement of Exempt Unit services.

Empire NY Priority HEDIS Measures recording link

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