Provider news
The latest articles and announcements on claims filings, products, benefits, administrative updates, new and revised procedures and guidelines, prescription information, and more.
Provider updates
It’s time for some of your patients to renew their Medicaid benefits
As states begin to recommence Medicaid renewals, we want to ensure you have the information needed to help your Medicaid patients renew their healthcare coverage.
Fraud, Waste and Abuse Prevention
Effective March 28, 2023
Under the revised rulemaking in 18 NYCRR Part 521 Fraud, Waste and Abuse Prevention, all NYS required providers shall provide a copy of their annual ETIN Form to the Health Plan for which they are a participating provider. Your ETIN Form contains certification that you have met the requirements of section 363-d of the Social Services Law and this SubPart. A copy of your ETIN Form must be provided upon signing the provider agreement with the Health Plan, and annually thereafter.
You may submit a copy of your ETIN Form to our Compliance Department via e-mail to: Michele.LoPorto@amerigroup.com
April 2023
Beginning April 1, 2023, all Medicaid members enrolled in Highmark Blue Cross Blue Shield of Western New York (Highmark BCBSWNY) will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. Information about the transition of the pharmacy benefit from Highmark BCBSWNY to NYRx, the Medicaid Pharmacy Program can be found HERE. General information about NYRx, the Medicaid Pharmacy Program can be found HERE along with information for Members and Providers
Child Health Plus Benefit Expansion
Highmark Blue Cross Blue Shield of Western New York (Highmark BCBSWNY) partners with Amerigroup companies to administer certain services to Medicaid Managed Care (MMC) and Child Health Plus (CHPlus) members. Please note, this information is specific to the MMC and CHPlus programs only.
Pharmacy Billing Guidance (Exceptions for Non-Enrolled Prescribers)
Updates to Pharmacy Billing Guidance for Interns, Residents and Foreign Physicians in training as well as Out-of-State (OOS) Licensed Prescribers who are treating Medicaid Members for a single instance of emergency care within 180 days.
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