Tour our updated provider website for the latest information We recently updated the Empire BlueCross BlueShield HealthPlus (Empire) provider website. This Quick Reference Guide provides navigation tips and screen shots for this valuable provider resource. Please note: we update our website regularly with the latest health plan and health care information. Always refer to the site for the latest information available. Figure 1 is the home page of the new Empire website for Medicaid and Fully Integrated Duals Advantage (FIDA) providers. You can access it by entering www.empireblue.com/nymedicaiddoc into the URL address field of your search engine. Figure 1: Provider homepage www.empireblue.com/nymedicaiddoc Empire BlueCross BlueShield HealthPlus is the trade name of HealthPlus, LLC, an independent licensee of the Blue Cross and Blue Shield Association. NYEPEC-0253-15 October 2015
Empire BlueCross BlueShield HealthPlus Page 2 of 6 This is the main page from which you can access all the latest resources for Medicaid members and FIDA participants health care services. Take some time to explore this website and check back with us frequently. We re constantly updating the pages to bring you the latest information and resources available so you can work more efficiently with the state-sponsored plans in New York. While we believe all the information on this website is important, we d like to point out a few key resources that you ll find very helpful. The Precertification & Claims page Select the Precertification & Claims tab (Figure 2) for access to the following pages and helpful resources: Figure 2: Precertification and Claims Precertification resources o Precertification Lookup Tool (PLUTO) to search for services requiring prior authorization o Clinical Utilization Management Guidelines o Reimbursement Policies for Medicaid and FIDA Submit Claims and Appeals o Link to the secure Availity website where you can submit claims and appeals and check on their status. Electronic Data Interchange o Electronic Data Interchange (EDI) Registration and important information about becoming a Trading Partner.
The Member Eligibility & Benefits page Empire BlueCross BlueShield HealthPlus Page 3 of 6 Figure 3 below shows what is available via the Member Eligibility & Benefits page of the new website. Figure 3: Member Eligibility & Benefits The Pharmacy page contains overview information concerning pharmacy benefits including links to formularies and/or PDLs, as well as Clinical Pharmacy Policies and important pharmacy phone numbers. Under Member Eligibility & Panel Listing you can access and download a complete Panel List of current PCP members assigned to you or log into Availity to make eligibility inquires. Once logged in to the secure self-service website, you can also access Patient 360 to get Medical Records for patients in which you are a part of their service or care team.
The Provider Support page Empire BlueCross BlueShield HealthPlus Page 4 of 6 As indicated by Figure 4 below, a wealth of resources, tools and information is available through the Provider Support tab of our new website. Figure 4: Provider Supports Forms The page is home to many of the forms you use on a regular basis, and we work hard to make sure that all are up-to-date and the most recent versions. The forms here fall into the categories of: General forms Behavioral health Prior authorization forms Helping members Under this heading, you will find information about the following programs and resources: Disease Management Centralized Care Unit (DMCCU) Health Homes Maternity and prenatal resources, including information and forms related to the New Baby, New Life/maternity management prenatal program Early and Periodic Screening, Diagnosis and Treatment (EPSDT), including contact numbers to call for more information on EPSDT services
Empire BlueCross BlueShield HealthPlus Page 5 of 6 Find a doctor This link allows providers to search for a doctor or a facility to learn if they are in our plan or network. Provider education Under this heading, you will find our library of current and past: Communications and Updates Provider Manuals, Directories and Quick Reference Cards Provider training and tutorial resources Quality assurance This page includes links to the following tools, information and resources: Medical Management Clinical Practice Guidelines Medical Policies Benefit partners This section provides links to our benefit partners for vision, dental, transportation and more! The Empire network For information about joining our network of valued physicians, select The Empire network tab and then Join Our Network from the resulting drop-down menu. This page contains contact information and resources covering our credentialing program and application process. Figure 4: The Empire Network
Empire BlueCross BlueShield HealthPlus Page 6 of 6 For more information Please remember to consult these web resources first whenever you have a question or need information. Many times, you ll find you can get answers quickly without a phone call. If you aren t able to find what you need online, please call our Provider Services team at: Medicaid providers: 1-800-450-8753 FIDA providers: 1-855-817-5790