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:
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.