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BLUE CROSS
BLUE SHIELD
UPDATES
Regulatory Updates
MEDIBLUE SELECT HMO NETWORK EXPANSION.

Effective January 1st, 2019 MediBlue Select HMO provider network expands. This network will support a specific line of Medicare Advantage products and programs focused on quality metrics and improvements. MediBlue Select HMO members will have Empire MediBlue Select (HMO) in the upper right-hand corner of their member ID cards.

More details here.

TRANSITION OF OUTPATIENT REHABILITATION UTILIZATION MANAGEMENT PROGRAM

Effective January 1st, 2019 Empire HealthPlus will transit its Outpatient Rehabilitation Utilization Management (UM) Program from OrthoNet to Empire (pending New York State Department of Health approval). The Outpatient Rehabilitation UM Program is a pre service medical necessity review of physical, occupational and speech therapy services.

For services that are scheduled to be rendered on or after January 1, 2019, physicians must contact Empire to obtain prior authorization for outpatient rehabilitation services. Empire will begin accepting these authorization requests on December 17, 2018. Providers are strongly encouraged to verify that a prior authorization has been obtained before scheduling and performing services

MEDICAL POLICY UPDATE

Effective November 1st, 2019 AIM Specialty Health (AIM) Musculoskeletal Level of Care Guidelines, Sleep Study Guidelines and Advanced Imaging Guidelines will be used for clinical reviews

HORIZON PLANS
UPDATE
Regulatory Updates

Effective January 1, 2019, Horizon Blue Cross Blue Shield of New Jersey will no longer administer Medicare Advantage (MA) PPO plans for the New Jersey State Health Benefits Program (SHBP). As a result, the Horizon Medicare Advantage NJ DIRECT10 (PPO) and Horizon Medicare Advantage NJ DIRECT15 (PPO) plans will be discontinued.

More details here.

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Insights
November 2018