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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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Search our online provider directory when you need a doctor, hospital or other health care provider.

ICD-10 Updates

As of October 1, 2015, Empire is LIVE with ICD-10 as the code set for medical diagnoses and inpatient hospital procedures in compliance with HIPAA requirements and in accordance with the rule issued by the U. S. Department of Health and Human Services (HHS). 
Important Notice to Paper Claim Filers – ICD Indicator on Claim Form
The ICD Indicator is required to be populated on paper claim forms. 
Reference Information for Providers 
ICD-10 Claims Billing Guidance by Service Type Reference Guide
Guidance on billing claims for services that SPAN the 10/1/2015 compliance date. 
ICD-10 Pre-Authorizations and Claims Filing Reference Chart
Guidance on pre-authorizations and general information on claims filing.  
Split Claims Billing Could Cause Overpayments
Guidance on how to handle overpayments due to split claims billing for services that span the 10/1/2015 compliance date 
New EDI Claim Edits for ICD-10 Claims
Check our EDI Latest News webpage for the most current EDI edits information.  
CMS 1500 Form Guidelines for Paper Claims
Guidance on our new requirements regarding the CMS1500 form 
Empire’s Response to the CMS/AMA Announcement
Our response to CMS/AMA’s 7/6/2015 announcement to assist providers in their ICD-10 transition.  
Empire ICD-10 FAQs for Providers
Empire-specific information and guidance for providers as well as answers about our ICD-10 transition.  
ICD-10 Basics FAQs for Providers
This FAQ contains educational information about ICD-10. 
ICD-10 Resources
Resources to help with your ICD-10 transition  
Contact Us 
For immediate and appropriate attention to any ICD-10 matter, please use your normal channels of communication for reporting and resolving issues and/or inquiries. 
Providers: Contact the Provider Service Call Center for the locality and line of business of your inquiry.
Clearinghouses: Please contact your Local E-Solutions Support or visit our EDI home webpage.
Vendors: Please contact your Account Management Representative.
Member-related inquiries: Please contact Customer Service listed on the back of the member’s ID card or visit Empire’s member home webpage.
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