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Dental Network Changing from DentaQuest to Healthplex in 2022
Our dental network partner is changing in 2022 from DentaQuest to Healthplex for certain dental products. Members who need dental care should be directed to our Find a Doctor directory. If additional assistance is needed, please contact Healthplex at 888-468-2183, Monday to Friday from 8 a.m. to 5 p.m.
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See What’s New for 2022
This year’s Annual Provider Notification is ready for you! The new year will bring important changes to our benefit plans, and simpler administrative processes for you and your team. Our annual notice also gives a recap of key changes that took place in 2021, and highlights regulatory requirements and trainings needed for your continued participation in our network. Information for ConnectiCare providers is included.
Be sure to visit emblemhealth.com/AnnualProviderNotice2021-2022.
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New Provider Portal
Save time and effort by taking advantage of our new, secure portal’s capabilities. Use it to upload documents in support of preauthorization requests, concurrent review determinations, customer service inquiries, and more.
ConnectiCare providers are urged to submit preauthorization requests, referrals, and ER Admission and Newborn Notifications online. Help us make faxes and phone calls a thing of the past. For help, see Educational materials and Frequently Asked Questions.
If you still have questions or need additional support, please contact Provider Customer Service at:
EmblemHealth: 866-447-9717
ConnectiCare: Commercial: 860-674-5850, Medicare: 877-224-8230.
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Dec. 1 is World AIDS Day
Dec. 1 is World AIDS Day. Studies show that better health outcomes result from strong provider-patient relationships, a multidisciplinary care team approach, and regular office visits. Refer your patients with HIV to an infectious disease specialist, if needed, and maintain ongoing communication for continuity of care. For more information, visit the CDC website.
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MEDICARE UPDATES
New Medicare Advantage Plan in 2022 for CNY Members
As we mentioned in previous newsletters, nearly 250,000 Medicare-eligible City of New York retirees are eligible to be transferred to the NYC Medicare Advantage Plus plan starting in 2022. The NYC Medicare Advantage Plus plan is a Medicare Advantage PPO group retiree offering through The Alliance, a collaboration between EmblemHealth and Empire BlueCross BlueShield. The plan allows retirees to visit any doctor nationally that accepts Medicare, while ensuring providers get paid their negotiated contractual rate or 100% of the Medicare-allowable rate if non-contracted (less any member copay).
To help you better manage these members in the new year, we have collected some important resources that you may find useful:
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Medicare Open Enrollment
Medicare open enrollment is underway. To see what is being offered in 2022, including new value-based benefits to help connect members to nutritious food, review our new Medicare Advantage web pages for EmblemHealth and ConnectiCare.
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EmblemHealth Medicare Service Area Changes for 2022
The following four plans will no longer be offered in the counties shown below:
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VIP Essential: Dutchess and Putnam
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VIP Value: Putnam and Sullivan
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VIP Dual Select: Richmond
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VIP Passport NYC: Richmond
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Members of these plans may choose another EmblemHealth Medicare plan available in their area before Dec. 7, 2021; otherwise, they will be enrolled in Original Medicare.
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POLICIES, BILLING AND CLAIMS
The ConnectiCare website is a rich source of information that helps your practice navigate ConnectiCare claims and billing processes. Check the website often to see new postings. Similar information can be found on EmblemHealth’s website.
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Reminder: Previously Announced Policy(ies)
We want to call to your attention this previously announced policy which you may start to see impact to your claims:
Multiple Endoscopy-Pay Percent
As announced in June, our Coding Edit Rules were updated to include a policy, Multiple Endoscopy-Pay Percent, that went into effect for claims submitted for dates of service on or after Sept 1, 2021. We now edit endoscopic procedure codes billed to align with CMS guidelines. Edits will apply to multiple endoscopic procedures performed for the same patient, by the same provider, on the same date of service.
EmblemHealth
ConnectiCare
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CLINICAL CORNER
Medical Policy Updates
All EmblemHealth and ConnectiCare Medical Policies are available for download from our provider websites.
New policy for ConnectiCare:
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Cortical Stimulation for Epilepsy (NeuroPace®)
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The following are the recently revised policies:
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Artificial Intervertebral Discs (EmblemHealth)
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Breast Implants and Reconstruction (EmblemHealth & ConnectiCare)
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Cortical Stimulation for Epilepsy (NeuroPace®)
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Cryosurgical Ablation for Prostate Cancer (EmblemHealth)
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Medical Guideline – Gene Expression Profiling (EmblemHealth)
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Transcatheter Aortic Valve Replacement (EmblemHealth & ConnectiCare)
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ConnectiCare is a brand name used for products and services provided by ConnectiCare Insurance Company Inc. and its affiliates, members of the EmblemHealth family of companies.
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