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Your Questions Answered
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What’s new

Quest Diagnostics and LabCorp can help with allergy testing for sufferers of asthma
For medical practitioners who have patients who suffer from asthma, specific IgE blood tests could be the answer. Quest Diagnostics and LabCorp blood tests can test for over 100 allergens.
Duplicate Claims Policy: Non-Physician Practitioner
EmblemHealth may consider claims as duplicate in cases where services performed by a Non-Physician and another practitioner with the same Tax ID.
2019 EmblemHealth Benefit Plans with No Referrals Required
EmblemHealth now offers plans which do not require referrals. These plans are available for both Medicare Advantage and commercial lines.
Medicaid Coverage Change for Child Annual Wellness Visits
For young EmblemHealth Medicaid members, aged 21 years or younger, wellness visits can now be performed on a calendar year basis. This differs from the previous scheme wherein young people could only visit once every 12 months.
New Utilization Management Pre-authorization List for Elective Services Starting August 1, 2019
It is the goal of EmblemHealth to guarantee that its members have access to quality health care services in suitable situations and environments. There will be 99 codes which will relate to the new 'site of service' rules.
Transgender Inclusion in Partnership in Care
Transgender individuals who are tested to be HIV negative may now be eligibile for the Partnership in Care scheme. The new rules came into play for those aforementioned transgender individuals in November 2017.
Certification as an HIV Specialist
Three types of specialization are currently available for practitioners who work with HIV patients and sufferers. The program is designed to encourage an understanding of the disease.
Reminder on Special Needs Plan Model of Care Training
All special needs plans are required by the Centers for Medicare and Medicaid Services to offer training for providers in Model of Care skills. Training should be offered on an initial and then the annual basis for providers of health care services.
New process for Out of Network Lab referrals
All lab services need to be referred onto a lab provider who is participating in the UnitedHealthcare program. Exceptions may be granted if a health care provider has the patient’s written consent and approval from UnitedHealthcare.
Proposed payment changes to hospitals
For those hospitals who provide Medicare and Medicaid services under the Inpatient Prospective Payment System and the Long Term Care Hospital Prospective Payment System, new rules will be coming into play for the Fiscal Year 2020.
Behavioral Health Transition to Medicaid Managed Care for Children Under 21 Years of Age
Effective July 1, 2019, the Medicaid Managed Care (MMC) benefit package is aligning the MMC behavioral health benefit. Beginning July 1, 2019, these services will no longer be covered by New York State Medicaid for any child under 21 years of age enrolled in an MMC plan or HIV SNP.
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June 2019