March 2020 In The Know

CORONAVIRUS (COVID-19) RESOURCES FOR PROVIDERS

EmblemHealth is committed to partnering with you to ensure our members have access to the services they need, especially during the coronavirus (COVID-19) outbreak. As this public health emergency continues to unfold, we will keep you informed with fact-based and regularly updated information. We ask you to please review the following:

• Please review our Temporary Telehealth Policy and Frequently Asked Questions. These documents can help you and your practice care for patients during this era of social distancing.
• Refer often to our dedicated provider COVID-19 section of our website. All new provider updates will be placed on this page.
• Preauthorization is not required for COVID-19 testing.
• Certain utilization management and emergency admission notifications were suspended by New York State until June 18. 
• Follow the CDC guidelines for screening and coding.
• New York State has opened a special enrollment period through April 15, 2020 to help uninsured New Yorkers get coverage as the coronavirus spreads. In addition, the Centers for Medicare & Medicaid Services (CMS) has opened a special enrollment period through May 31, 2020 for people eligible for Medicare plans.
• Our member Frequently Asked Questions document has information you can share with your patients.

All EmblemHealth plan members who use an in-network provider have no cost-sharing (including copayments, coinsurance, or deductibles) for the diagnostic visit and lab test for COVID-19, as well as in-network telehealth visits whether or not that visit includes testing for COVID-19. For more information and guidance, please review the letter sent to all providers. The letter also directs you not to collect any payments from any EmblemHealth member for these specific services. At this time, copayments, coinsurance, or annual deductibles will apply as usual for follow-up care or treatment, including for inpatient hospital admissions.

Delayed Implementation of New Century Health Oncology Program

EmblemHealth has decided to delay the implementation of the Oncology program due to the COVID-19 outbreak. All oncology-related chemotherapeutic drugs and supportive agents requiring preauthorization should continue to be sent to EmblemHealth.

Current email addresses needed

Please ensure we have current email addresses for all clinicians in your practice so we can get them urgent information quickly. If they have not received this newsletter, please have them log in to emblemhealth.com/providers to send us their updated email.

Bridge Program – Your Feedback, Our Changes

We appreciate our providers who have pointed out opportunities for us to make our Bridge member ID cards and provider portal eligibility transactions better. As a result, we have updated our provider portal. A member search will show “Bridge” instead of “EmblemHealth” to indicate that as an EmblemHealth provider, you can see Bridge members. We are also reissuing member ID cards to clarify thatEmblemHealth administers the Bridge offering. We hope these changes make it easier for EmblemHealth-contracted providers to identify and recognize Bridge members. See the February 2020 In The Know provider newsletter.

“K” IDs Are Not Just for EmblemHealth Members

Bridge members and EmblemHealth PPO members who have transitioned to our new systems upon their plans’ renewal will have “K” IDs (i.e., member IDs starting with the letter “K”). EmblemHealth PPO membership will be transitioning throughout 2020. Please ask members if they have new ID cards at each appointment.

2020 EmblemHealth Collabor8™Program

EmblemHealth created the Collabor8 program with one of our partners, Pulse8, to utilize during visits with our Commercial (New York State of Health Marketplace), Medicare Advantage, and Medicaid members to assess and document their chronic conditions. This year’s program covers dates of service from Jan. 1 to Dec. 31, 2020. Please use Collabor8, a web-based tool found on theEmblemHealth Provider Portal, to assess and document patient encounters/office visits. EmblemHealth will pay for proper use of this tool in addition to the regular fee schedule.

We encourage you and your staff to take advantage of Pulse8’s free, monthly, 60-minute Risk Adjustment Webinars. Register to see how you can improve your medical record documentation and claims coding. If you have questions about the Collabor8 tool or the Pulse8 resources available to you, call their Customer Support team at 844-878-5738 between 8 a.m. and 8 p.m. or email them at support@pulse8.com.

MEDICARE UPDATES

CCI Choice Network Access for EmblemHealth’s Medicare Members

EmblemHealth Medicare Advantage members with the following plans and who have a ConnectiCare (CCI) logo on their ID card may access CCI Choice Network providers for non-carved-out services:

EmblemHealth VIP Value (HMO)
EmblemHealth VIP Gold (HMO)
EmblemHealth VIP Essential (HMO)
EmblemHealth VIP Gold Plus (HMO)
EmblemHealth VIP Premier (HMO) Group
EmblemHealth VIP Rx Carve-Out (HMO) Group
EmblemHealth VIP Rx Saver (HMO)
EmblemHealth VIP Part B Saver (HMO)
EmblemHealth VIP Go (HMO-POS)
EmblemHealth VIP Passport (HMO)
EmblemHealth VIP Passport NYC (HMO)

Carved-out services (e.g., dental, vision, behavioral health, physical and occupational therapies, etc.) must be provided by EmblemHealth’s partners who serve the VIP Prime Network, not those contracted for the CCI Choice Network. Similarly, members with the CCI Choice Network who have an EmblemHealth logo on their ID cards may access the VIP Prime Network. Providers need to follow CCI's plan rules and use designated CCI partners for certain services. Refer to the 2020 Medicare Advantage Guide available in our Provider Toolkit

Medicaid: New York State Medicaid Update

The Office of Health Insurance Programs of the New York State Department of Health has posted its January 2020 and March 2020 Special Edition - COVID 19 Coverage and Reimbursement Policy and March Special Edition - COVID 19 Telephonic Communication Services. See Medicaid Updates.

CLAIMS CORNER The Claims Corner section of our website is a rich source of information that helps your practice navigate EmblemHealth claims and billing processes. Please check often to see posted updates. Key items to note: New Outpatient Facility Policy Enhancements In-Office Testing List to Cover All EmblemHealth Members Sign Up for Free for EFT/ERA Through PNC Remittance Advantage, you can receive direct deposits to your bank account(s) electronic funds transfer (EFT) and view or download your remittances online electronic remittance advantage (ERA). Electronic transactions are fast, convenient, and reduce the risk of lost or stolen payments. This solution is free and reduces payment processing costs and improves cash flow. Visit PNC Remittance Advantage, click on the “Register Now” button, and follow the instructions to enroll. Read More.

CLINICAL CORNER 2020 Plans with No Referrals Please share this updated reference tool with your appointment schedulers. Clinical Resources The following are available for download in Clinical Corner on our provider website. > UM & Medical Management – Preauthorization Rules Clinical Practice Guidelines (CPGs) Medical Policies Medical Technologies Database Notable update: Newly approved medical technology – Coronavirus (COVID-19) diagnostic testing (e.g., CDC 2019-Novel Coronavirus [2019-nCoV] Real-Time RT-PCR Diagnostic Panel)

PHARMACY EmblemHealth updates its Formulary on a regular basis. Find our most recent updates here. Reminder: Accredo’s Convenient Care Program Starts April 1 EmblemHealth’s program to provide home infusion treatments through Accredo’s Convenient Care Program starts April 1. More Reminder: Specialty Drugs Not Covered in an Outpatient Setting Effective March 1, 2020, certain specialty drugs are no longer covered in an outpatient setting. Members using an outpatient setting for their treatments are responsible for the full cost of their drugs and treatment.

WEBINAR/TRAINING Live Seminars and Webinars for Providers EmblemHealth Instructor-Led Webinar for Physicians and Office Staff – Wednesday, April 8 from 10 a.m. to 11 a.m., or from 2 p.m. to 3 p.m. Join us for overview of our products and benefit plans, special utilization management programs, and a lesson on how to navigate our provider portal. Register today as space is limited. Free Pulse8 Webinars for Patient Management and ICD-10 Coding on April 21 and April 23 – Keep Your Skin in the Game: Uncovering the Disease of the Integumentary System. Register for this webinar and see other topics listed on our website.