| | | | Provider News Bulletin Winter 2023 | | | | A Message from Our Medical Director | |
Dear Colleagues,
I’m 90 days into my new role as Medical Director for non-profit Partners Health Plan (PHP) and could not be happier being part of a team with such deep commitment and operational experience serving individuals with intellectual and developmental disabilities (IDD) and those that care for, and about, them.
As part of the PHP Provider Network, I know you share the same level of enthusiasm for our mission to support individuals with IDD to succeed in the world on their own terms and participate – emotionally, socially, and economically – as active members of family and community.
Having been the Chief Medical Officer for a national primary care practice and accountable care organization serving homebound, disabled adults I am intimately familiar with some of the ‘tensions’ that can occur between payers and providers. However, we look forward to expanding our “shared care” relationship with the provider communities (developmental disability agencies, healthcare and behavioral health professionals, habilitation services providers) that will allow us to fulfill the mission. The fact is that individuals with intellectual and developmental disabilities (IDD) face a number of social and systemic challenges to their health, well-being, and quality of life. In addition to shorter life expectancy and prevalence of chronic conditions, they face stigma, exclusion, and inadequate access to disability-competent services. To address the broad needs of our members, PHP is designed on non-traditional managed care model that takes a very broad view what constitutes “health” for individuals with IDD; no other health plan invests in the whole person as PHP does. You can count on our PHP Care Managers – all Qualified Intellectual Disability Specialists – to work with you to coordinate care and augment your staff to support access, scheduling, and transportation to healthcare and other resources (e.g., community programs, employment, housing, OPWDD Waiver services) required for person-centered support. Feel free to reach out to them! Over the next few months, we will be launching a number of specialized programs to support mission-driven care, quality management, and professional development, and look forward to your participation and feedback. Please feel free to reach out to me with any questions or other considerations.
--Steven Merahn, MD smerahn@phpcares.org
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Please review our 2023 Provider Manual, CLICK HERE.
| | | | | | How to Receive Assistance from PHP's Network Development & Provider Relations Team | |
In order to contact the Provider Relations department to request assistance or information, please open a ticket using the Provider Ticket Submission Form. Once a ticket is submitted, a Provider Relations team member will reach out to you as soon as possible. | | | | | | New Non-Emergency Transportation Vendor | |
PHP responded to feedback from our members and transitioned to a new non-emergency (NEMT) vendor effective January 1, 2023. We are very excited to announce that we have selected Ride Health to manage all NEMT needs for our community-based members. Ride Health’s call center is available for reservations 24/7/365 at 1-844-982-3194.
For more information on Ride Health, please visit their website. | | | | | |
Provider Relations Initiatives | |
Return to In-Person: The NDPR team is excited to get back into the field and meet with providers! If you’d like to meet with a representative from NDPR for a meeting or invite us to a community event, please reach out to your NDPR Account Manager or open a ticket with NDPR.
Provider Spotlight Series: The Provider Spotlight series is an opportunity for providers to showcase their services to PHP Clinical Team Leaders and Care Managers. We are seeking DD, healthcare or behavioral health providers, community organizations and more to present to our team. This series will allow PHP staff to learn the latest and greatest information that your organization has to offer and make referrals to your organization. If you are interested in presenting, please open a ticket and a member of our team will be in touch. 
Provider Satisfaction Survey: Thank you to all who participated in PHP’s 2022 Provider Satisfaction Survey. The results are currently under review, and we will develop a comprehensive action plan to address any challenges that will be shared with the provider community. | | | | | |
We are Excited to Welcome Some of the New Providers Added to Our Network!
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- LI Medical Group, PLLC
- AI Medical Urgent Care, PLLC
- Dimitri N. Kessaris, MD PC
- Home Health Pavilion, Inc.
- Total Quality Health & Rehab Services, Inc.
- Elena Epstein Shahom, LCSW
- Bardy Diagnostics
- BHRAGS Homecare Inc.
- Jean L Minkel, PT LLC, DBA On A Roll
- Heba A Zaher, MD
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Thank You to the Providers Who Recently Presented at Our Provider Spotlight Series! | | | | | | | | | |
By Premila Kumar, Chief of Quality Initiatives
The Healthcare Effectiveness Data and Information Set (HEDIS) is one of healthcare’s most widely used performance improvement tools. Partners Health Plan (PHP) is required to submit data to the National Committee for Quality Assurance (NCQA) every year to demonstrate how well PHP members are taking care of themselves for preventive and chronic care quality measures. HEDIS measures are reported to NCQA using administrative (claims data) or hybrid methodology, which is a mix of claims data and medical record chart reviews.
PHP will conduct HEDIS medical chart reviews for members who lack HEDIS compliant claims or medical records already on file. This process will ensure that HEDIS measurements accurately represent the services delivered to the members we support together. It is our sincere goal to conduct these reviews with minimal disruption to our providers. This year PHP has contracted with a new vendor, Cotiviti, to conduct our HEDIS medical chart reviews from February through May of 2023. Our goal is for our Providers to bill using HEDIS compliant coding, so you can get the credit you deserve for promoting excellence in clinical care. Billing with standard HEDIS compliant codes will also minimize the burden on Providers of the Plan conducting chart reviews during active HEDIS season. To help Providers minimize the burden of chart reviews/request, Partners Health Plan is happy to provide best practice training around HEDIS compliant coding and documentation, tips on how practices can improve their scores and decrease their gaps in care. If you are interested, please contact Premila Kumar, Chief of Quality Initiatives at pkumar@phpcares.org or via phone at 646-883-9905. | | | | | | | |
PHP is proud of our partnership with DentaQuest to increase access to oral health care for individuals with intellectual and/or developmental disabilities (IDD). We will be hosting our first mobile dental clinic on Saturday, February 18, 2023, at our office headquarters located at 2500 Halsey Street in the Bronx. If you are a PHP network provider and would like to partner with us on a mobile dental clinic, please reach out to us! View our recent press release on this initiative here. | | | | | | | |
PHP has an in-house team of DME specialists to assist in ordering Durable Medical Equipment, Prosthetics, Orthotics, and Medical Supplies for PHP Care Complete FIDA-IDD Plan Participants. If a patient you support needs any DME/POS items, please ensure that a complete script and letter of medical necessity (LOMN) is provided to PHP in a timely manner. You can reach our DME team by phone at 646-455-1594 and by fax at 646-948-1027. Abbott Formula Shortage
Following a voluntary recall of powdered formulas by Abbott Nutrition in 2022, there is a nationwide shortage of Abbott’s nutrition drinks on the market, as well. PHP’s DME department would like to remind providers that there are substitute products available from other manufacturers available on the market. A new physician order will be required to transition your patients to an alternate product. The following formulas were most affected: - Ensure Enlive
- Ensure HP
- Ensure Original
- Ensure Plus
- Juven 1.2 Cal
- Juven 1.5 Cal
- Fruit Punch
- Osmolite Punch
- Jevity
View latest communication from Abbott on this situation, here.
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Claims Submission Made Easy PHP would like to remind our providers of the ease of establishing and submitting claims electronically. In addition, we would like to also remind everyone to regularly confirm with their billing service (Clearinghouse) that all electronic submissions have been successfully transmitted and received. If the claim is not successfully transmitted, there will be delays in PHP’s ability to adjudicate the claims on a timely basis. Please check all error logs and resubmit the claim accordingly – timely filing rules still apply for resubmissions. - Balance Billing is not Permitted
- Please be reminded that under New York State Law, a Provider participating in the Medicaid program, or a Medicaid Managed Care plan, is prohibited from requesting any monetary compensation from a Medicaid beneficiary, or their responsible relative. In addition, a Medicaid beneficiary, including a Medicaid managed care member, must not be referred to a collection agency for collection of unpaid medical bills or otherwise billed.
- To ensure prompt adjudication, please remember to send all claims to PHP using one of the following options:
- Mail
- Partners Health Plan P.O. Box 16309 Lubbock, TX 79490
- Electronic Submission
- Set up electronic claim submissions
- Change HealthCare EDI Claim Submission Change HealthCare Submitter ID: 14966 Change HealthCare
- Phone: 888-363-3361 (Note: a fee will be charged for setting up electronic claims mission online)
- You may also call HealthSmart Clearinghouse at 888-744-6638 to set up the electronic claim submission (free of charge).
- Web-based Claims Submission
- Providers can now easily create and upload a professional or institutional single claim as a pdf file via the provider portal (https://php.healthsmart.com).
- Web-based claims are considered paper claims and will follow all existing claim submission protocols.
- Please note that only valid claim forms (CMS 1500 or UB 04) may be updated using this method
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Credentialing/Re-Credentialing - Keep All Information Updated | | Please send us any changes to your organization’s demographic information, as well as any updates to individual providers to ensure we always have the most up to date information loaded in our system!
PHP’s re-credentialing timeframe is every 3 years. We appreciate your cooperation with our re-credentialing process. | | | | | | | | PHP will be hosting webinars for our provider network on a quarterly basis in 2023. Please see our 2023 training schedule below and be on the lookout for registration opportunities.
| | | | | | | | | | | | Do you have questions or concerns? Here's how to receive assistance from the Partners Health Plan’s Network Development and Provider Relations team! Partners Health Plan’s Network Development and Provider Relations team has updated our ticketing process! Going forward, in order to contact the Provider Relations department to request assistance or information, please open a ticket using the Provider Ticket Submission Form.
Once a ticket is submitted, a Provider Relations team member will reach out to you as soon as possible. If an email is sent to providerrelations@phpcares.org, an automatic email message will be sent prompting the submitter to use the Provider Ticket Submission Form to contact Provider Relations. | | CLICK HERE to view all previous PHP Provider Newsletters. | | | | | | | |
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