News & Announcements

Empire BlueCross BlueShield HealthPlus (Empire) adopts MCG Care Guidelines for clinical reviews of mental health services

Empire BlueCross BlueShield HealthPlus will be using Milliman Care Guidelines for review of inpatient and outpatient mental health prior authorization requests. See attachment to learn more.

Empire Blue Cross and Blue Shield changes to OTC pharmacy formulary benefit

Effective July 15, 2018, Empire Blue Cross and Blue Shield will remove several OTC drugs from the pharmacy benefit. Pharmacy claims submitted for these OTC medications after the effective date will reject at the pharmacy point-of-service. No prior authorization will be allowed to access these products

Rehabilitation Skilled Nursing facility Milliman Care Guidelines

Empire BlueCross BlueShield HealthPlus (Empire) has extended the use of InterQual criteria through October 31, 2018. See the attachment to learn more.

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