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Provider News Bulletin Spring 2023 | |
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A Message from Our Medical Director | |
It’s a very exciting time for Partners Health Plan! We are celebrating our seventh year of operation serving the IDD community in New York State, but also celebrating your support of our efforts to bring IDD-competent care to the community.
Thanks to you working with us and to our Care Managers, our members:
- Receive evidence-based preventive measures at higher rates that other health plans
- Are able to secure services and supports faster than other service systems
- Are healthy; our hospitalization rates are below average for special needs populations
We have some ambitious plans for 2023-2024, including some special programs for both our healthcare professional and developmental disability providers: - We’re launching a quarterly “Clinical Brief” newsletter that sources and summarizing important articles from the medical and disability professional literature
- We’re expanding our claims data sharing program to help you get the full picture of our members health status and make better decisions
- Developing a special pilot program to treat challenging behavior
- We are committed to making every effort to simplify the process by which we share medical records and other information
Partners Health Plan is proud to have you as our partner, sharing the care of individuals with IDD and those that care for, and about, them.
--Steven Merahn, MD smerahn@phpcares.org
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Important Updates & Resources | | | |
End of Public Health Emergency – How will this Impact the use of StationMD for Behavioral Health?
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As you know, PHP has been working with StationMD since 2018, the outcomes from this benefit for members has been extremely positive and we will continue our relationship with StationMD as we move past the Public Health Emergency. We wanted to share some updates as to how this will change some of the flexibilities that were allowed over the past 3 years. | |
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Reminder – NEW Non-Emergency Transportation Vendor! | |
PHP selected Ride Health to manage all NEMT needs for our community-based members effective January 1, 2023. Ride Health’s call center is available for reservations 24/7/365 at 1-844-982-3194. | |
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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. | |
Thank you to our valued network providers! | | | |
We are Excited to Welcome the Providers Recently Added to our Network. Thank you for supporting individuals with IDD! | |
- Braverhood, LTD
- AID Physicians, PC
- River Manor Corp DBA Atrium Center for Rehabilitation and Nursing
- NY Gastroenterology &
Liver Disease, PC
- Lincare Inc.
- Community Resources and Services for Children, Inc.
- The Center for Prosthetics and Orthotics
- Community Assistance Resources and Extended Services, Inc. (CARES)
- Flexy Move Physical Therapy, PLLC
| | - Jean L Minkel, PT LLC DBA On a Roll
- South Shore Family Practice
- Gotham Eye Medical DBA New York Ophthalmology
- Schweiger Dermatology Group
- Total Medical Supply, Inc.
- StatMD Physicians, PLLC
- Good Shepherd Primary Care, PC
- New Hillside Medical, LLC
- Center Span LLC
- Unique Care Community Services, Inc.
- CareND Provider Group, P.A.
- Najate Ojeil, LMHC
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Thank You to the Providers Who Recently Presented at Our Provider Spotlight Series! | |
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PHP at the 2023 Medicaid Managed Care Summit Hosted by BRI Network | |
Scott Doolan RN, BSN, MBA, AVP Health Care Management presented at the 2023 Medicaid Managed Care Summit on March 30, 2023.
PHP is continuously looking to improve the type, accessibility, and quality of healthcare services available for members. As part of this innovative approach, an Urgent and Emergent Telemedicine Program was piloted in collaboration with StationMD. The success of this pilot program demonstrated the potential for achieving quality healthcare outcomes for people with IDD. A full-scale program was implemented enabling proactive, vital 24/7 healthcare support during the COVID-19 pandemic and will be continued to be included as part of our benefits package. Data gathered and analyzed illustrates consistent results in achieving high quality medical care with a significant financial cost reduction. | |
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Provider Webinars and Trainings | |
Did you miss our provider webinar on March 22, titled What is IDD Care Management & what is it to me? Not to worry! See the webinar presentation HERE.
Please see below for our upcoming provider training schedule and be on the lookout for registration opportunities: | |
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Do you want a one-on-one training from PHP for your staff? Let us know and we will be happy to coordinate a training. | |
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Consumer Assessment of Health Plan Providers & Systems Survey | |
How can you help improve the CAHPS Survey Rates?
Consumer Assessment of Health Plan Providers and System (CAHPS) is an annual standardized survey conducted by CMS from March to June every year, to assess consumers’ experience with their provider and health plan. A random sample of Partners Health Plan (PHP) members are selected for the CAHPS survey by CMS and your patients may get the survey. Satisfaction not only helps to increase patient retention but can also help increase adherence to physician recommendations and improve patient outcomes. 2022 CAHPS Survey results demonstrated providers performed well in Care Coordination: - Doctors talking about prescription medications
- Got help managing care
- Personal doctor’s office followed up to give test results
- Got test results as soon as they needed
- Annual Flu Vaccination rates
Opportunities for improvement were noted in questions related to getting an appointment with a specialist; obtaining needed care quickly and seeing providers within 15 minutes of appointment time. We can work together for a positive experience that will benefit your practice and increase patient satisfaction. | |
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Specialized Mobile Dental Clinic for PHP Members | |
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PHP partnered with Solvere Health to host our first mobile dental clinic on Saturday, February 18, 2023, at our office headquarters located at 2500 Halsey Street in the Bronx.
We will be offering mobile dental clinics throughout our service area to target members with barriers to dental care.
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If you would like to partner with us on a mobile dental clinic, please reach out to us! | |
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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. PHP developed a thorough DME resource page on our website. Please review and let us know if you have any questions. If you’d like a one-on-one training with our team, please reach out and we will coordinate. | |
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MediSked Portal for DD Providers | |
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SEMP Frequently Asked Questions | |
PHP developed a Supported Employment (SEMP) Frequently Asked Questions Document to assist our DD provider partners who render SEMP services. | |
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Medicaid Recertifications Provider Guidance | |
After nearly 3 years of automatic Medicaid recertifications due to COVID flexibilities, recipients will again be required to recertify their Medicaid in the near future. With the ending of the Public Health Emergency (PHE), Medicaid cases expiring in June 2023 will have to be recertified. Failure to recertify will result in cases being closed and a person will need to reapply. | |
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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.
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Eligibility & Claims Status for All Providers | |
Do you want to avoid placing a phone call to our Provider Services call center? You’re in luck! You can check a member’s eligibility and claim status using our online portal.
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For more information, please visit the Provider Portal page on our website, or contact the applicable Care Manager. | |
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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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