Blue Cross Blue Shield of New York Empire

Providers - New York Empire

Welcome, providers!

Resources that help healthcare professionals do what they do best — care for our members.

At Empire BlueCross BlueShield HealthPlus (Empire), we value you as a provider in our network. That's why we’ve redesigned the provider site to make it more useful for you and easier to use.

Interested in joining our provider network? We look forward to working with you to provide quality services to our members.

COVID-19 information

Empire BlueCross BlueShield HealthPlus is closely monitoring COVID-19 developments and how the novel coronavirus will impact our customers and provider partners.

Vaccine Resources

Vaccination is important in fighting against infectious diseases. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and patients against contagious illnesses.

Availity access

The Availity Portal* offers healthcare professionals free access to real-time information and instant responses in a consistent format regardless of the payer.

At Availity, you can:

Request authorizations.
Submit claims.
Confirm eligibility.

Learning opportunities

Find learning opportunities to assist with administering your patient’s health plan using Availity Essentials multi-payer features and payer spaces applications. Use the library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. Be prepared with the knowledge to assist our members.

Receive email from Empire

Empire is now sending some bulletins, policy change notifications, prior authorization update information, educational opportunities and more to providers via email.

Provider news

The latest Empire articles and announcements on Medicaid Managed Care policies, processes, updates to clinical guidelines, claims filings, state and federal regulatory changes, and more:

Medicaid updates


 

Changes to Medicaid Managed Care Pharmacy Benefits

Beginning April 1, 2023, all Medicaid members enrolled in Empire BlueCross BlueShield HealthPlus (Empire) will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. Information about the transition of the pharmacy benefit from Empire to NYRx, the Medicaid Pharmacy Program can be found HERE. General information about NYRx, the Medicaid Pharmacy Program can be found HERE along with information for Members and Providers

 

Pharmacy Billing Guidance (Exceptions for Non-Enrolled Prescribers)

Updates to Pharmacy Billing Guidance for Interns, Residents and Foreign Physicians in training as well as Out-of-State (OOS) Licensed Prescribers who are treating Medicaid Members for a single instance of emergency care within 180 days.

Policy Clarification for Practitioner Dispensing

New York State Education (NYSED) Law, Article 137 §6807, authorizes practitioners, who are authorized to prescribe, to dispense medications directly to their patients. This dispensing must be done in accordance with federal, State, and New York State (NYS) Medicaid program policies for dispensing, billing, and record keeping.

 

9/1/22 Medicaid Enrollment Requirement Notice

Effective September 1, 2022, Empire BlueCross BlueShield HealthPlus members must use providers (e.g., pharmacies, providers, and specialists) enrolled with the NYS Medicaid program. These providers must have a valid Medicaid ID.

 

Register today: Exploring the intersection of race and disability

Empire is committed to making healthcare simpler and reducing health disparities. Open discussion about the disability experience for people of color and reducing implicit bias for those in healthcare is critical to improving the health and well-being of the communities in which we live and serve — all Americans.

 

Featured resources

Pharmacy information

Search for up-to-date drug information, including hundreds of brand-name and generic medications.

Maternal child program

When it comes to our pregnant members, we are committed to keeping both mom and baby healthy. That’s why we encourage all our moms-to-be to take part in our New Baby, New LifeSM program, which is a comprehensive, proactive case management and care coordination program for all expectant mothers and their newborns.

Behavioral health providers

We work collaboratively with hospitals, group practices and independent behavioral healthcare providers, community and government agencies, human service districts, and other resources. This enables Empire to meet the needs of members with mental health and substance use disorders as well as those with intellectual and developmental disabilities.

Looking for Medicare, duals or HMO plan information from Empire?

Please visit the Empire BlueCross BlueShield HealthPlus commercial website for more information.

Government resources

New York State Department of Health - Medicaid

Provider tools & resources

Interested in becoming a provider in the Empire network?

We look forward to working with you to provide quality services to our members.