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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements
View requirements for Local Plan and BlueCard Out-of-Area members.

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Information about Health Insurance Exchanges

PW_E197232
Find critical updates about the new products that are effective on 01/01/14 and the provider networks supporting these new health plans.  
 
2015  
Important update about Empire’s 2015 ACA-compliant health plans
Member ID card update for 2015 Small and Individual health plans
Access more information about three month grace period status electronically
 
2014  
Update on member ID cards for plans purchased on and off the Exchange
Update regarding self-injected drug coverage for ACA-compliant health plans
2014 Medical chart review for members who have purchased plans on or off the Exchange – Begin July
Inovalon continues outreach efforts on Empire’s behalf to help identify members needing care
Verify member grace period status electronically using Availity or EDI
Empire engages Inovalon to conduct outreach efforts for our Exchange business
Grace period for individual health plans purchased on the Exchange
Important drug list information for plans purchased on and off the Exchange
Most individual and small group members will have new health plans in 2014
Important information about provider referrals for plans purchased on and off the Exchange
New provider networks will support health plans sold by Empire on and off the NYS Health Insurance Marketplace
The new Health Insurance Marketplace - Important Terms and Definitions.
The New Pathway and Pathway Enhanced Provider Networks are coming in January 2014
 
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