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Working With Us

Click on the articles below for more educational information and updates to our policies. 

  • Managed Care for Members with Special Needs Including Medicare Advantage Dual-Eligibles

    The following drug therapy guidelines have been updated. Please refer to these updated guidelines when discussing treatment options with your BlueShield of Northeastern NY patients.
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  • Opting Out of Medicare

    Federal regulations prohibit Medicare Advantage (MA) organizations, including BlueShield of Northeastern NY, from paying for services rendered by physicians or practitioners who have chosen to opt out of the Medicare program, except in limited circumstances.
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  • Out-of-Plan Referral Guidelines

    Out-of-plan (OOP) referrals should be requested for BlueShield of Northeastern New York patients only when the patient is outside his or her service area or, participating providers in the area cannot provide the necessary services.
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  • Perceived Denials

    We appreciate and support your efforts to manage your BlueShield of Northeastern NY Medicare Advantage patients’ care in a prudent, cost-effective manner. The Centers for Medicare & Medicaid Services (CMS) requires that members who perceive denial of treatment or care are entitled to certain appeal rights under federal law.
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  • Updating Your Provider Information

    Health plans are required by Centers for Medicare & Medicaid Services (CMS) and other regulatory entities to have accurate information in provider directories, which are routinely reviewed and audited.
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Working with Us

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