Provider News & Communications

Dear Valued Provider:

If you don’t help your patients act soon, they will lose their Medicaid coverage. While Medicaid members were automatically renewed over the Pandemic, the Public Health Emergency ended in May and enrollees must now go through a rigorous and complex redetermination process to keep their Medicaid coverage.

All members in the following MetroPlusHealth Plans are impacted:

• Medicaid Managed Care
• Child Health Plus (CHP)
• Essential Plan
• Enhanced (HARP) Plan
• Partnership in Care (PIC) HIV SNP
• UltraCare (MAP)

Losing coverage will mean disruption of care, negatively impacting the health of your patients, a decline in your patient roster, the potential for claim denials due to eligibility and a negative impact on incentive-based rewards.

5 things all Healthcare Providers of care can do today:
1. Direct members to MetroPlusHealth Customer Success Specialist via phone at 212.908.3300 or online at https://metroplus.org/renew/
2. Utilize all patient interactions to remind patients of the need to renew coverage
3. Make use of MetroPlusHealth’s recertification collateral (brochures, banners, fliers, etc.) Providers can send an email to [email protected] to request these materials.
4. Ensure front line staff are verifying recertification dates during registration, scheduling, etc. so there is no gap in coverage. Front line staff should re-familiarize themselves with the recertification process, including documentation needed to submit for member renewal as members will be receiving notices regarding renewal which will result in increased questions and requests for assistance.
5. Primary Care Practices can get a roster of their MetroPlusHealth members with the recertification date by logging in to the Provider Portal at https://metroplushealth.my.site.com/Providers/s/login/.

Questions? The Provider Call Center can help. Call 800.303.9626.

Thank you, as always, for all you do to support our members.

MetroPlusHealth

Effective August 27, 2013, most prescribers are required to consult the Prescription Monitoring Program (PMP) Registry when writing prescriptions for Schedule II, III, and IV controlled substances. The PMP Registry provides practitioners with direct, secure access to view dispensed controlled substance prescription histories for their patients. The PMP is available 24 hours a day/7 days a week via an application on the Health Commerce System (HCS) website. Patient reports will include all controlled substances that were dispensed in New York State and reported by the pharmacy/dispenser for the past year. This information will allow practitioners to better evaluate their patients’ treatment with controlled substances and determine whether there may be abuse or non-medical use. If a Provider is unable to conduct a PMP check, the Provider should document a good faith effort, including the reason why the Provider is unable to conduct a PMP check. For questions related to the Prescription Monitoring Program, the NYS Department of Health Bureau of Narcotic Enforcement has a toll-free number that you can call: 1-866-811-7957 or visit here for more information.

The Deficit Reduction Act of 2005 (DRA) requires Medicaid agencies to collect NDC numbers on pharmaceuticals. Our NDC billing requirements for providers enrolled in the 340B Program can be found here.

Read our NDC billing requirements for 340B Program providers here.