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.