Two surgeons performing a procedure

Change Healthcare Service Interruption 

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. We set-up a “Command Center” with useful information, such as eligibility checks, claims process, electronic remittance advices and more.  

ARTICLE 29-I VFCA HEALTH FACILITY PARTICIPATING PROVIDERS

New York State has implemented a one-time, short-term waiver of timely filing requirements allowing 29-I Facility providers to resubmit claims that were denied due to untimely filing due by March 31, 2024.  Claims must be submitted within two years of the date of service provided on or after April 1, 2022.

Transabdominal/Transvaginal Ultrasound Payment Policy

MetroPlusHealth supports CMS (Centers for Medicare and Medicaid Services) as it relates to multiple procedure payment reductions for diagnostic imaging furnished on the same day by the same physician/physician group /health care provider for the same patient encounter.  According to our records, MetroPlusHealth has identified your practice as performing non-obstetrical transabdominal/pelvic and transvaginal ultrasounds that may be subject to multiple procedure payment reductions.

Introducing ClarisHealth

MetroPlusHealth has recently partnered with ClarisHealth to periodically conduct reviews on adjudicated claims to ensure compliance with industry standards.  We wanted to let you know, ClarisHealth  may make Medical Records Requests (MRRs) on behalf of MetroPlusHealth. These requests are not designed to monitor your practice or your practice’s billing or coding patterns.

THE CAHPS SURVEY IS COMING THIS SPRING!


Your patients’ direct feedback is important:

The CAHPS survey helps us understand your patients’ experience with accessing care, getting appointments quickly and receiving clear communication from their doctors.

Positive patient experiences = better health outcomes:
When patients feel heard and cared for, they are more likely to follow treatment plans and have better overall health.

Benefits to member, providers, and health plan:
Members who perceive the care provided by their provider and health plan as a positive experience are more likely to give higher CAHPS scores benefiting both you and MetroPlusHealth.

Effective March 2024, MetroPlusHealth will be partnering with Verisys to simplify our credentialing process

Great news for our valued providers, like you. Effective March 2024, MetroPlusHealth will be partnering with Verisys to simplify our credentialing process.

Verisys is an industry leader in provider data management, credentialing, and sanction monitoring, delivering comprehensive profiles of verified provider data. Hundreds of large health care organizations and related stakeholders partner with Verisys to streamline processes, accelerate verifications, and enable compliant, aligned provider networks.

This new partnership will make the following credentialing functions seamless for our provider network:

  • Credentialing verification services for providers and facilities undergoing the initial credentialing or recredentialing process. This includes activities such as:
    • Reviewing and retrieving New York State CAQH ProView applications/MetroPlusHealth Organizational Provider applications;
    • Gathering supporting documentation; and
    • Primary Source Verification of provider information, such as board certification, licensure, etc.

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.

Two young men skateboarding in a bike lane in front of the arch in Washington Square Park
Join Our Network

Want to become a MetroPlusHealth provider?

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.

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  

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:

The New York State Office of Addiction Services and Supports (OASAS) has made the overdose reversal medication Naloxone (Narcan) and fentanyl test strips available to all OMH service providers. You can access OASAS’s new easy-to-use ordering system here.

Pedestrians crossing a busy intersection in a crosswalk

Great care and services…don’t forget the MetroPlusHealth reward programs. Been with MetroPlusHealth for 38 years and still going strong.

Aliska R.
Google Review
last updated: March 15, 2024

Ready to Join Us?

Talk to us about questions or concerns

Monday–Saturday | 8 a.m.–8 p.m. (ET)
Sunday | 9 a.m.–5 p.m. (ET)

Already A Member?

Talk To Us About Any Questions or Concerns

Monday–Saturday | 8 a.m.–6 p.m. (ET)
Sunday | 9 a.m.–5 p.m. (ET)

Speak To Someone In Your Community

Find someone in your neighborhood and in your language