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.
- Provider Digital Engagement Supplement
- Centers of Medical Excellence Transplant Operations Manual
- MLTC Provider Manual
- CHPlus benefit expansion
- Provider Manual
- Essential Plan Provider Manual
- New York Medicaid provider quick reference card
- Behavioral Health Quick Reference Benefit Grid
- Behavioral health quick reference guide
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.
- Clinical Utilization Management Criteria February 2023
- November 2022 Clinical Utilization Management 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
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Reimbursement Policies
- Provider Manuals, Policies & Guidelines
- Referrals
- Provider Training Academy
- Forms
- Pharmacy Information
- Provider News & Announcements