Provider manuals, policies & guidelines
Empire BlueCross BlueShield HealthPlus (Empire) is committed to supporting you in providing quality care and services to the members in our network. Here, you will find Empire provider manuals, guidelines for clinical Utilization Management (UM) and medical policies.
Provider manuals and quick reference guides
Empire provider manuals provide key administrative information, details regarding programs that include the utilization management program and case management programs, quality standards for provider participation, guidelines for claims and appeals, and more.
Medical policies and clinical UM guidelines
Medical policies address the medical necessity of new services or procedures and new applications of existing services or procedures. Clinical UM guidelines focus on detailed selection criteria, goal length of stay, and location for generally accepted technologies or services.
We routinely update Medical Policies and Clinical UM Guidelines as part of the review process. Please visit Medical Policies & Clinical UM Guidelines: Full List on the Empire website to view or search for specific medical policies and Clinical UM Guidelines.
- August 2022 Clinical Utilization Management Guidelines
- February 2022 Clinical Utilization Management (UM) Guidelines
- November 2021 Clinical Utilization Management (UM) Guidelines
- August 2021 Clinical Utilization Management (UM) Guidelines
- May 2021 Clinical Utilization Management (UM) Guidelines
- February 2021 Clinical Utilization Management (UM) Guidelines
- November 2020 Clinical Utilization Management (UM) Guidelines
- Clinical practice guidelines matrix
- May 2020 clinical utilization management (UM) guidelines
- February 2020 clinical utilization management (um) guidelines
- Preventive health care guidelines
Related resources
- HEDIS Coding Booklet 2023
- HEDIS Category II Coding Bulletin 2023
- HEDIS ECDS Prenatal and Postpartum Care Coding Bulletin 2023
- HEDIS Well Child and Immunizations Coding Bulletin 2023
- HEDIS Desktop Reference Guide 2023
- HEDIS telehealth eligible measures coding bulletin
- HEDIS Desktop Reference Guide 2022
Provider tools & resources
- Log in to Availity
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- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
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- Provider Manuals, Policies & Guidelines
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