Friday, November 29, 2013

Health Care Reform Updates

Beginning January 1, 2014, Pre-existing Waiting Periods to be Removed

The Affordable Care Act (or ACA) includes a provision that eliminates pre-existing condition waiting periods from all health plans. Please note that this provision applies to health plans upon their renewal on or after January 1, 2014. This means that pre- existing waiting periods will be removed from health plans at various times throughout 2014, based upon the renewal date of t he member’s policy. After January 1, 2014, please continue to verify eligibility and benefits for all members. This verification process will provide you with member specific benefit information and whether or not pre-existing waiting periods still apply to a member’s health plan.

The Affordable Care Act - Defined and Detailed

Health care reform law (also known as the Affordable Care Act or ACA) will continue to bring changes to the health care field in 2014. These changes include the ability for consumers to purchase health plans through the Health Insurance Marketplace (also known as the Exchange). The law also calls for the development of ACA compliant health plans that may be purchased off the exchange.

Definition and Details: The comprehensive health care reform law enacted in March 2010, in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” is used to refer to the final, amended version of the law.

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Wednesday, November 20, 2013

Availity's Web Portal Now Available for Empire Blue Cross BlueShield

Register for Availity’s Web Portal today!

As you may know, Empire BlueCross BlueShield has partnered with Availity to offer a multi-payer portal solution that gives you and your user’s secure, single sign-on access to information from multiple health plans. You can access Empire Eligibility, Benefits, Claims Status, care reminders and patient care summaries on Availity for free. Availity also offers access to ask a question about a claim via Secure Messaging, link to online remittances, and to submit your requests to AIM Specialty HealthSM (AIM).

Due to the Availity Web Portal’s ease of use, broad functionality and breadth of services, Empire will transition eligibility, benefit and claims status inquiry from Physician Online Services and Facility Online Services to exclusive access via Availity’s Web Portal. To avoid any disruption to accessing information electronically, you will want to be fully transitioned to Availity prior to shutdown. Please register now and begin accessing this information on Availity’s Web Portal at

Note: Electronic transactions submitted via our Enterprise EDI Gateway are unaffected; you may continue to submit all X12 transactions through your current EDI transmission channels.

Availity’s Web Portal currently offers Empire providers access to the following functionality at no cost:

  • Eligibility and benefits
  • Care reminders
  • Claim status
  • Patient care summaries

Availity’s Web Portal also offers link to Empire’s:

  • Secure Messaging
  • AIM Specialty HealthSM (AIM)
  • Online Remittance
  • Empire Provider Home page and other key Empire resources through the Payer Resources tab

How do we get registered for Availity’s Web Portal?

  • Go to
  • Click Register Now.
  • Complete the online registration wizard.
  • You will receive an e-mail from Availity with temporary password and next steps
  • If you need further assistance from Availity, please contact Client Services at 1-800-282-4548.


Wednesday, November 13, 2013

News for MVP Partners With PaySpan

MVP partners with PaySpan®

MVP was excited to announce in September that they have partnered with PaySpan to offer providers the health care industry’s leading solution for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs) coming in 2014. This service is provided at no cost and allows online enrollment.

If you are a health care provider, you know that the time your staff spends on payment issues and reconciliation is time taken away from patient needs. Using this free service you can take advantage of EFTs and ERAs to settle claims electronically, without making an investment in expensive EDI software. Following a quick online enrollment, you will be able to receive ERAs and import the information directly into your Practice Management or Patient Accounting System, eliminating the need to key remittance data off of paper advices.

Using PaySpan® will rapidly transition providers into the world of electronic payments and automated reconciliation, greatly reducing paper work. Providers will be offered a complete solution for claim payment management including routing EFTs to the bank account(s) of their choice, managing multiple payers, choosing how to receive remittance details, easily re­associating payments with claims and taking advantage of claim and remittance retrieval and reporting.

Provider who are already using PaySpan for other payers, just need to add MVP to their PaySpan profile. They will keep the same username and password they currently have through PaySpan and their banking information will remain the same. Providers not using PaySpan already will receive a letter in the coming months with specific sign up information once registration for MVP is open.


Friday, November 8, 2013

Important Information About SIDES

SIDES stands for Unemployment Insurance State Information Data Exchange System. Here is some helpful information produced by the NYS Department of Labor to answer all your questions about SIDES. (To read the full article, click here.)

What is SIDES?

SIDES, the Unemployment Insurance State Information Data Exchange System, is a new, web-based system that puts the Department of Labor and employers in direct contact. The system transmits questions from the Department of Labor about Unemployment Insurance claims by former employees directly to you, and helps you respond to questions about claims easily, accurately, and in a timely manner.

There are two aspects of SIDES:
• E-Response: For employers with small numbers of employees and no representative (i.e. payroll agent), the SIDES E-Response system provides an easy way for you to electronically respond to our questions and requests.
• The Broker: For larger employers, SIDES provides a more automated and efficient data sharing and file-tracking interface between you, your Third Party Administrators, and state agency networks than current systems. Because the computer systems are “speaking” to each other, SIDES provides the most reliable and efficient way to deal with your transactions.

How does SIDES help me?

One of the main causes of improper Unemployment Insurance payments to workers is a lack of accurate information about why a worker left or lost his or her job. In order to prevent improper benefit payments, we need employers to respond to our requests accurately, completely and in a timely manner. When you do this, you help us protect your business and prevent possible fraud.

SIDES has many other benefits for you:

• It is FREE to use.
• It offers one nationally-standardized format for information requests.
• Data checks ensure the exchange of complete and valid information.
• You receive requests for information faster, which means you can respond faster.
• You receive a receipt as proof that your timely reply was processed.
• It offers a single point of contact for questions and answers.
• Fewer follow-up phone calls and less correspondence are needed.
• It lowers your postage costs and generates less paper.
• It improves fraud detection.

In short, SIDES helps you respond to our questions about your former employees’ termination quickly and completely. This prevents payments from going to people who do not deserve them, while preserving the integrity of the UI trust fund and your employer account. Preventing fraud ultimately saves employers money.

When will SIDES be available?

SIDES will be phased in beginning late in 2013.

How do I sign up for SIDES?

There are just two easy steps:

1. If you DO NOT have an Unemployment Insurance Online Services account, go to

If you HAVE AN EXISTING Department of Taxation and Finance Online Services account, you can upgrade that account by following the directions on our website at Authentication/index.shtm.

2. Call 1-888-899-8810

How will I be notified of a request? How do I respond?

Whenever a former employee applies for Unemployment Insurance benefits, you will receive an electronic SIDES message through your Unemployment Insurance Online Services account.

For more information about SIDES: Check out the SIDES user guides and get more information at the SIDES website.

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Thursday, November 7, 2013

Unemployment Insurance Reform for Employers

Unemployment Insurance provides benefits to workers who lose their job through no fault of their own. Every state has its own Unemployment Insurance system overseen by the federal government. Here are some things you may need to know about New York State's Unemployment Program as released by the NYS Labor Department. To read the full article, click here.

How Unemployment Insurance is Funded

The program is funded by employer contributions. Employers in the state pay two types of Unemployment insurance contributions:
• The Federal Unemployment Tax Act (FUTA) pays for program administration at the federal and state level, federal unemployment extensions, and loans to states. The FUTA contribution rate is the same for all employers.
• The New York State Unemployment Insurance contribution pays for regular state benefits to claimants. The contribution rate is based largely on how many employees an employer has laid off and, to a lesser extent, the financial health of the Unemployment insurance Trust Fund.

Employers receive a credit on the FUTA when they are current on their state contributions, though that credit can be reduced when the state has outstanding federal loans.

Why Reform Was Needed

The Unemployment Insurance Trust Fund is Insolvent.
The Trust Fund holds the money that pays for weekly benefits. The state is forced to borrow from the federal government when contributions paid by employers are insufficient to pay benefits to workers.
To cover increased costs during the recession, New York, like many other states, borrowed from the federal government. At the beginning of 2013, New York owed $3.5 billion. By law, employers are responsible for paying back this money, with interest, to the federal government. Charges by the federal government are billed to employers at a flat rate through higher FUTA rates and interest assessments.

• The Cost to Employers is High and Unpredictable.
Without reform, the Trust Fund would have remained insolvent, unable to weather changes in economic conditions.

What Reform Does

1) Reduces Interest Payments.
As a result of the reforms, it is anticipated that employers will be able to pay off the $3.5 billion debt to the federal government by 2016 – two years earlier than planned – reducing interest payments by nearly $200 million.
Estimated Savings To Employers (over a ten year period)
Capital Region - $21 million
Central New York - $16 million
Finger Lakes - $24 million
Hudson Valley -  $41 million
Long Island - $60 million
Mohawk Valley - $8 million
New York City - $183 million
North Country - $6 million
Southern Tier - $11 million
Western New York - $30 million
Statewide - $400 million

2) Improves Sustainability and Predictability - Reform restructures the Unemployment Insurance system to make it self-correcting and sustainable.

3) Prevents Fraud - New fraud detection and prevention measures will help combat Unemployment Insurance fraud.

4) Brings Equity - Reform will ensure that employers are not charged for a former employee’s claim when the loss of employment was the employee’s fault.

5) Encourages Claimants to Return to Work - Reform will require claimants to look for work more aggressively and thereby return to work quickly.

Reform Measures Already In Place

The Shared Work program provides an alternative to laying off workers by providing partial Unemployment Insurance benefits to employees during temporary declines in business. Also, benefits are now available for up to 26 weeks. As a result of changes in state law, this expanded program will run through August 2015, when federal reimbursement is scheduled to end.

Reform Measures That Take Effect October 1, 2013

Late Response - Pursuant to a federal requirement, an employer will not be relieved of charges to their account if there is an overpayment to a claimant because the employer or their representative (for example a payroll agent) responded to department of labor inquiries late or with insufficient information

Reform Measures that Begin January 1, 2014

Wage Base - Employers pay Unemployment Insurance contributions on each employee’s earnings up to a certain threshold called the wage base.

The wage base will be adjusted on January 1 of each year as follows:
2014 - $10,300
2015 - $10,500
2016 - $10,700
2017 - $10,900
2018 - $11,100
2019 - $11,400
2020 - $11,600
2021 - $11,800
2022 - $12,000
2023 - $12,300
2024 - $12,500
2025 - $12,800
2026 - $13,000

Contribution Rate Schedules - Reform eliminates the six lowest contribution rates for employers. As the Trust Fund balance increases, contribution rates for all employers will decrease.

Re-qualification Standard - Claimants will have to earn 10 times their benefit rate in order to re-qualify for benefits after exhausting benefits or being disqualified for misconduct, a voluntary quit without good cause, or declining a job offer.

Dismissal or Severance Pay - If a claimant receives dismissal or severance pay that is greater than the maximum benefit rate, he or she will not be able to collect benefits.

Pension Payments - If a claimant is collecting a pension from an employer that is chargeable on the claim and that employer contributed to the pension, the claimant will not be able to collect benefits.

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Monday, September 2, 2013

CDPHP Providers Important Information - Medicare Modernization Act Means Document Submission

Recently, CDPHP contacted its providers to inform them that the Centers for Medicare and Medicaid Services (CMS) has implemented a risk-adjustment methodology for all Medicare Advantage beneficiaries. As part of their participation in the Medicare program, CDPHP is obligated to submit all documented ICD-9-CM codes associated with provider's patients who are members of their Medicare Advantage health plans to CMS on an annual basis.

CDPHP is partnering with Altegra Health, Inc., a health care consulting services firm, in a data collection process that will be initiated in the near future. Be assured that this effort is not an audit; the data is needed for CMS and CDPHP to get an accurate picture of health status of their Medicaid members.

If you are a CDPHP provider, you may receive a call from a representative of Altegra Health, who will share further details about this project. CDPHP assures that this will be done with as little disruption to your practice as possible. Records may be scanned onsite or sent back to Altegra Health via fax.

Furthermore, CDPHP has entered into a Health Insurance Portability and Accountability Act (HIPAA) Business Associate Agreement with Altegra Health for this purpose. Accordingly, the release of this information to Altegra Health is permissible under HIPAA. Altegra Health maintains the security of data as required under HIPAA and its Business Associate Agreement with CDPHP.

If you are a CDPHP Provider, and you have any questions about this project, contact the CDPHP Provider Services Department at 1-800-926-7526 or 1-518-641-3500.

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Thursday, August 22, 2013

Taking a Closer Look at the NY Medicaid EHR Incentive Program

The New York Medicaid Electronic Health Records (EHR) Incentive Program provides financial incentives to eligible practitioners and hospitals to promote the transition to electronic health records. Providers who practice using EHR's are in the forefront of improving quality, reducing costs, and addressing health disparities. Since December 2011 over $381 million in incentive funds have been distributed to over 7,200 New York State Medicaid providers.

For more information, go to

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