Archive for the ‘HEALTH INSURER UPDATES’ Category


Empire Provider/Facility Online Services Shutdown – Register for Availity now!

Friday, January 10th, 2014

Member eligibility, benefits and claims status functionalities moving exclusively to the Availity Web Portal

Empire is transitioning member eligibility, benefit, and claim status from Provider/Facility Online Services to the Availity Web Portal on March 14, 2014.  Availity, at is your new source to access this valuable information. To avoid any disruption to accessing information electronically, you will want to be fully transitioned to Availity prior to shut down. Please register now and begin accessing this information on Availity.

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 currently offers Empire providers access to the following functionality:

  • Eligibility and benefits inquiry
  • Claims inquiry
  • Claims submission
  • Secure messaging
  • Patient care summaries
  • Care reminders
  • AIM Specialty HealthSM
  • Direct access to your legacy portal – Link to your existing functionality, i.e. fee schedules, online remittances etc. using the link located under My Payer Portal in the left navigation bar.

How to get started

To register for access to Availity, go to It’s that simple!

Free Training

Once you log into the Availity Main Menu page, you’ll have access to many resources to help jumpstart your learning, including free live training, on-demand training, frequently asked questions, and comprehensive help topics. To view current training resources, click Free Training at the top of any page in the Availity Web Portal or click to find a current schedule of FREE Availity workshops and webinars.

Client service representatives are also available Monday through Friday (8:00am – 7:00pm ET) to answer your questions at 800-AVAILITY (800-282-4548).

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If Your MA Plan Has Dumped You, Contact MSSNY

Monday, November 25th, 2013


There is a litany of national news service articles this week, covering the full political spectrum, highlighted concerns expressed by physicians in New York State regarding unfair  treatment  by health insurance companies offering coverage in New York’s Health Insurance Exchange.

Articles appeared in:

·         Wall Street Journal

·         US News & World Report and

·         Kaiser Health News highlighting the challenges patients may face in New York’s Health Insurance
Exchange as a result of a number of concerns identified through the preliminary results ofMSSNY
survey gauging physician experiences with health insurance companies offering coverage through
New York’s Health Insurance Exchange.

The problems with health insurers identified in the MSSNY survey include failure to communicate whether a physician is part of an Exchange plan, failure to provide information regarding reimbursement for providing needed patient care and, in many cases, offering fees that, generally speaking, are significantly below existing commercial coverage. MSSNY continues to regularly communicate with top staff at the New York Exchange to convey these concerns.  Last week’s MSSNY’s Advocacy Matters program featured top staff of the New York Health Insurance Exchange describing the roll-out of the Exchange in New York, including responding to many physicians’ questions.  To watch a recording of this webinar, click here.

We also continue to urge physicians to complete the survey so that it is more representative of physician experiences statewide.  If you have not already done so, we urge you to please complete the survey here.

We Need to Hear from You

MSSNY has contacted the NYS Department of Health regarding complaints of some physicians that they are listed as a participating physician in a health plan exchange network, but were not provided any  written notice by the health plan that gave  prior notification of such participation requirement, or the terms and conditions of such participation, including but not limited to, the fee schedule applicable to the exchange product.  The NYS Department of Health has asked MSSNY to provide specific examples of physicians who believe that the health plan failed to provide prior written notice of participation in the exchange product. If a physician is interested in having the DOH investigate the specifics, the doctor should send an email to Regina McNally, VP of Socio-Medical Economics at The email should identify the plan name and identify whether or not they have any contract with the specific insurer.

Sam L. Unterricht, MD

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EmblemHealth’s Current Small Group, Sole Proprietor and Individual Plans will be Discontinued as of January 1

Friday, August 16th, 2013

Streamlining Small Group and Sole Proprietor
Plans for 2014

The Affordable Care Act (ACA) and New York State Law require that starting January 1, 2014, all health insurance plans include a core set of health services (known as essential health benefits) and more cost-sharing choices. While EmblemHealth’s plans already offer many of these benefits, we will be replacing our current products with new, fully ACA-compliant plans.

On December 31, 2013, all of EmblemHealth’s current small group, sole proprietor and individual plans will be discontinued. As of January 1, 2014, EmblemHealth will offer new small group and individual plans that will meet the ACA requirements.

Notifying Small Groups and Subscribers

We are mailing letters announcing the discontinuance to affected small groups, small group subscribers, and sole proprietors about 90 days before the effective date. This will provide ample time for your clients to consider their options in the marketplace.

Sole Proprietor

Under the ACA, when a business is owned only by an individual or an individual and his or her spouse, these individuals are not considered “employees” and the benefit plan is not considered a group health plan. As of January 1, 2014, these individuals will no longer be able to purchase group coverage and will need to purchase individual coverage.

If you have questions about the plan discontinuance, please contact your EmblemHealth representative.

More Information

Next month, we will be sending you more details about the discontinuance and news about our ACA- compliant products.


Don’t Miss Claims Filing Deadline for United HealthCare Settlement

Tuesday, September 14th, 2010

Have you submitted your Claims Information Request Authorization Form and returned it to the Settlement Claims Administrator?
All claims must be postmarked no later than October 5, 2010.

To assist you in completing your Claim, you can request a report from the Settlement Claims Administrator that lists the Covered Out-Of-Network Services or Supplies that you provided January 1, 2002 through May 28, 2010.

However, you must authorize the Settlement Claims Administrator to send you this information
. You must complete and sign the authorization form on the bottom of page 15 of the Claim Form to:

United HealthCare Class Action Litigation
c/o Berdon Claims Administrator, LLC
P.O. Box 15000
Jericho, New York 11853-0001
About the Litigation
MSSNY, the AMA and other parties filed a class action lawsuit against Defendants and alleged that Defendants provided insufficient reimbursement amounts for Covered Out-of-Network Services or Supplies including by:
· using a flawed database (the “Ingenix Databases) in determing reimbursement for Covered Out-Of-Network health benefits;
· using the out-of-network policies to reduce reimbursement amounts improperly for covered out-of-network health benefits; and
· inadequately disclosing the use of the Ingenix Databases and their out-of-network reimbursement policies.
There are Two Settlement Agreements
1)       The Cash Settlement – The Settlement establishes a Cash Settlement Fund in the amount of $350 million plus accrued interest. If the Settlement Agreement is finally approved by the Court, members of the Settlement Class who submit a timely Claim Form will be entitled to payments from the Cash Settlement Fund.
2)       Business Practice Initiatives – As part of the Settlement Agreement, and consistent with the terms of the separate “Assurance of Discontinuance” entered into with the New York State Attorney General, Defendants have agreed to certain commitments regarding their reimbursement practices and procedures for out-of-network healthcare benefits. United Health Group and its affiliates have agreed that they (a) will stop using the Ingenix Database that MSSNY and AMA allege are flawed, and, in their place, will use a New Database independently established and operated by a consortium of New York State university-level schools of public health led by Syracuse University; and (b) will contribute $50 million towards the funding and implementation of the New Database (in addition to the $350 million payment to the Cash Settlement Fund). The New York State Attorney General has entered into similar “Assurance of Discontinuance” agreements with the largest health insurers in the state, resulting in total contribution of nearly $100 million to support the New Data Base. The Report from the Settlement Claims Administrator may help you to complete the Claim Form.
Because the deadline to submit the Claim Form is October 5, 2010, it is very important to submit your Claims Information Request Authorization Form as soon as possible, if you haven’t already done so.

For more information, go to:
Berdon Claims Administration, LLC
Toll Free#: 1-800-443-1073 begin_of_the_skype_highlighting 1-800-443-1073 end_of_the_skype_highlighting
Facsimile: (516) 222-0271

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