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For Providers
COMMUNITY HEALTH WORKER SERVICES FOR PREGNANT AND POSTPARTUM MEMBERS
RETROACTIVE: Effective October 1, 2023, MetroPlusHealth will reimburse Community Health Worker (CHW) services* for pregnant and postpartum populations. Medicaid members are eligible for CHW services during pregnancy and up to 12 months after the end of pregnancy, regardless of how the pregnancy ends.
Updated Provider Letter Regarding Foster Care 2023
As a MetroPlusHealth network provider, you may find yourself in a position to provide trauma-informed care to Medicaid Managed Care (MMC) children/youth in direct placement foster care and in the care of Voluntary Foster Care Agencies (VFCA).
Provision and coordination of services for children/youth in foster care, must be done in compliance with the New York Medicaid Program 29-I Health Facility Billing Manual and the Transition of Children Placed in Foster Care and NYS Public Health Law Article 29-I Health Facility Services into Medicaid Managed Care guidance documents located at:
https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/vol_foster_trans.htm.
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IMPORTANT MESSAGE FROM THE UTILIZATION MANAGEMENT DEPARTMENT TO PROVIDERS SERVICING MEMBERS WITH MEDICAID INCLUDING HARP AND PARTNERSHIP IN CARE (HIV SPECIAL NEEDS PLAN) COVERAGE RECEIVING:
• PERSONAL CARE SERVICES (PCS)
• CONSUMER-DIRECTED PERSONAL ASSISTANCE SERVICES (CDPAS)
Effective 10/10/2023, MetroPlusHealth is directing providers who were submitting requests via email to submit them BY FAX instead.
• This change is for all lines of business receiving PCS or CDPAS, including Medicaid, HARP, and Partnership in Care (HIV special needs plan).
• As a result of this change, the following email account will no longer be available: [email protected]
• The PCS/CDPAS fax number remains: 212-908-5237.
• The ability to submit request by telephone has not changed.
• Providers are encouraged to use the Home Care Services Request Form.
Please visit the MetroPlusHealth website for details and continued updates related to Utilization Management. Thank you for the care you provide our members.
Utilization Management Department
UPDATED New York State Medicaid Coverage Policy and Billing Guidance for Pharmacy Providers for the 2023-2024 COVID-19 Vaccines
Attention Pharmacy Providers:
Updated billing guidance to bill NYRx, the New York State Medicaid Fee-for-Service pharmacy program for all Medicaid members enrolled in MetroPlusHealth Medicaid, Partnership In Care, and Enhanced (HARP) plans for COVID-19 Vaccines can be located here. For any NYRx billing and claim questions, please contact the eMedNY Call Center at (800) 343-9000.
Model of Care Webinar
Join us for a special MetroPlusHealth Provider Webinar. Complete your required annual MOC training while you learn more about how to make your patients thrive!
New York State Department of Health (NYSDOH) Extends Post-Partum Health Coverage from 60 Days to 12 Months for Medicaid and Child Health Plus
CMS has approved the duration of this benefit extension allowing NYSDOH to provide Medicaid and CHPlus pregnant enrollees with 12 months of postpartum coverage following pregnancy, regardless of immigration status or how the pregnancy ended.
NOTIFICATION TO PROVIDERS REGARDING CHANGES TO COMPLIANCE CERTIFICATION REQUIREMENT
Providers who submit electronic claims to the New York State Medicaid Program are required by MetroPlusHealth to retain in the provider’s profile, a copy of the signed and notarized Certification Statement on a yearly basis. This annual certification shall occur on the anniversary date of the provider’s enrollment in Medicaid.
Important Information on Covid 19 Services Coverage Â
As of May 12, 2023, MetroPlusHealth will no longer cover COVID testing from out of network providers including laboratory PCR and antigen testing for all lines of business, except in limited circumstances such as emergency services rendered in a hospital. COVID testing will still be covered for qualified in-network providers.
URGENT MESSAGE: YOUR PATIENTS WILL LOSE THEIR MEDICAID COVERAGE UNLESS THEY RENEW
HELP PATIENTS PREVENT DIABETES WITH LIFESTYLE TIPS
Lifestyle changes can make a big difference in preventing diabetes.
IMPORTANT MESSAGE FOR OUR BEHAVIORAL HEALTH PROVIDERS
IMPORTANT MESSAGE FOR OUR PROVIDERS:
Great care and services…don’t forget the MetroPlusHealth reward programs. Been with MetroPlusHealth for 38 years and still going strong.
last updated: December 6, 2023
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