Become a Health Care Hero
Become one of the more than 34,000 top New York providers that make up MetroPlusHealth’s ever-growing network.
Welcome to MetroPlusHealth!
Welcome to MetroPlusHealth’s Provider page – a dedicated resource designed to support our healthcare providers. Here, you can access essential tools, resources, and updates to help you deliver exceptional care to MetroPlusHealth members. From eligibility verification and claims submissions to prior authorization forms and provider manuals, we’re here to streamline your partnership with us. Together, we ensure the health and well-being of our communities.
We’re happy to have you join us.
With a focus on primary and preventive health care for people not profit, we’ve been providing a caring, high-quality customer experience for New Yorkers since 1985.
Important & Urgent Notifications
Already part of our network?
The Provider Portal is your one-stop shop for:
- Checking member eligibility and authorization statuses
- Tracking submitted claims
- Accessing information like orientation materials, benefit changes, and membership rosters
- Procuring membership and utilization reports
- Browsing provider performance profiles and diagnosis code lists
- And more!
Change Healthcare (CHC) Outage Updates
Change Healthcare was the target of a cyberattack on February 21 that disrupted a number of its services and systems. To address the outside threat, Change Healthcare took immediate action, including disconnecting internal systems to safeguard sensitive information and prevent further impact. Change Healthcare is carefully monitoring the situation and will provide updates on efforts to resolve the threat and return to normal operations. In the meantime, providers should be aware of the following key impacts.
MetroPlusHealth is here to help you.
We exist to serve the community. That means helping providers like you deliver the best health care in the city while growing your business along the way.
How large is the MetroPlusHealth network?
Our network is always expanding! But to date, our network includes more than 34,000 providers like you, 40 hospitals, 110 urgent care centers, and 500 local and national pharmacies. Our Provider Search is a great place to get specifics.
What is the billing process?
We accept both electronic and paper-based claims. Log into the Provider Portal to any time.
What does the reimbursement process look like?
Both capitation and fee-for-service claims have to include a detailing of all services rendered within 90 days of the date of service. We ask our providers to kindly allow 30 days for the reimbursement of electronic claims and 45 days for the reimbursement of paper claims.
What does the authorization process look like?
We issue an Explanation of Payment (EOP) for every claim and adjustment regardless of whether payment or denial. Our EOPs offer a summary of payment or denial information for each billed service.
How many specialists are in network?
Our network is comprised of over 34,000 providers and specialists.
How many hospitals are in network?
There are more than 40 hospitals and urgent care centers in our network including NYC Health + Hospitals, NYU Langone, Mt. Sinai, CityMD, Montefiore, Labcorp, Lenox Hill Radiology, and more.