Our providers know that everything from rules and regulations to best practices and cutting-edge innovations are always evolving across the healthcare landscape.
From timely reminders about combating antibiotic resistance to updates on Medicaid, Medicare, and more, our news service gives our providers the up-to-date information they need to deliver the best care possible.
Important & Urgent Notifications
March 14, 2025
URGENT MESSAGE FOR YOUR PATIENTS AND THEIR PAID CAREGIVERS REGARDING CDPAP CHANGE
March 12, 2025
RE: COVERAGE OF HYPOGLOSSAL NERVE STIMULATORS
March 10, 2025
RE: Important Message from the Managed Long-Term Care Department to Providers Servicing Members with Medicaid and Medicare Coverage Receiving:
March 05, 2025
RE: Status Update of Extension of Implementation of NYS OASAS COP Rate Codes
February 28, 2025
RE: HOME SLEEP TEST
February 26, 2025
RE: All Personalized Recovery Oriented Services (PROS) Providers
February 11, 2025
MetroPlusHealth’s Partnership with BetterDoctor: FAQ
February 11, 2025
MetroPlusHealth is proud to announce our 2025 Provider Pay for Performance (P4P) program
February 05, 2025
COVERAGE AND REIMBURSEMENT OF EVISITS
14 Mar
URGENT MESSAGE FOR YOUR PATIENTS AND THEIR PAID CAREGIVERS REGARDING CDPAP CHANGE
Your patients who participate in the Consumer Directed Personal Assistance Program (CDPAP), and/or their personal assistant(s), must take IMMEDIATE ACTION…
12 Mar
RE: COVERAGE OF HYPOGLOSSAL NERVE STIMULATORS
TO: MEDICAID MANAGED CARE PROVIDERS Dear MetroPlus Health Provider, Effective March 1, 2025, per New York State (NYS) Medicaid guidance,…
10 Mar
RE: Important Message from the Managed Long-Term Care Department to Providers Servicing Members with Medicaid and Medicare Coverage Receiving:
Personal Care Services (PCS) Consumer-Directed Personal Assistance Services (CDPAS) Dear MetroPlusHealth Provider, Effective April 7, 2025, MetroPlusHealth will start directing…
05 Mar
RE: Status Update of Extension of Implementation of NYS OASAS COP Rate Codes
TO: OASAS Comprehensive Outpatient Program (COP) Providers Dear MetroPlusHealth Provider, The New York State Office of Addiction Services and Supports…
28 Feb
RE: HOME SLEEP TEST
TO: MEDICAID MANAGED CARE PROVIDERS Effective December 1, 2024 onwards, per New York State (NYS) Medicaid guidance, MetroPlusHealth will begin…
26 Feb
RE: All Personalized Recovery Oriented Services (PROS) Providers
In July 2024, NYS submitted the proposed State Plan Amendment (SPA) #23-0098 to the Center for Medicaid and Medicare Services…
11 Feb
MetroPlusHealth’s Partnership with BetterDoctor: FAQ
1. What is BetterDoctor? BetterDoctor, a division of Quest Analytics®, provides reliable provider network and verification services. By using the…
11 Feb
MetroPlusHealth is proud to announce our 2025 Provider Pay for Performance (P4P) program
This program rewards providers who meet specific goals for delivering quality and efficient care goals to MetroPlusHealth members enrolled in…
05 Feb
COVERAGE AND REIMBURSEMENT OF EVISITS
TO: MEDICAID PROVIDERS (Retro) Effective October 1st, 2023, per New York State (NYS) Medicaid guidance update, MetroPlusHealth is allowing reimbursement…
04 Feb
Removal of Primary Care Provider (PCP) Name on ID Card
Starting November 1, 2024, MetroPlusHealth member ID cards for newly enrolled members or reissued member cards, will no longer reflect…
24 Jan
Expanded Reimbursement To Population For Adverse Childhood Experiences Screening
IMPACTED PLANS: MAINSTREAM MEDICAID, HIV SNP, and HARP Dear MetroPlusHealth Provider: Effective January 1, 2025, per updated mandate issued by…
24 Jan
Health Homes Serving Children Providers
IMPACTED PLANS: Medicaid and HIV SNP Effective October 1, 2024, the New York State Department of Health (NYSDOH) has received…
15 Jan
Self-administered Hormonal Contraception Medication Without a Prescription
Effective January 1, 2024, Governor Kathy Hochul authorized New York State pharmacists to dispense three types of self-administered hormonal contraception…
08 Jan
NCD PrEP for HIV Prevention 2025
Effective Date:9/30/24 Impacted Plans:MetroPlus UltraCare, MetroPlus Medicare Advantage and MetroPlus Platinum. Dear MetroPlusHealth Provider: As of September 30, 2024, MetroPlus…
31 Dec
Health Homes Serving Children Providers
DATE: 10/15/2024 – NYS DOH Memo Release IMPACTED PLANS: Medicaid and HIV SNP Dear MetroPlusHealth Provider, DOH has released guidance…
31 Dec
ALL Children HCBS and Health Home Providers
DATE: 12/01/24 IMPACTED PLANS: Child Health Plus (CHP) Dear MetroPlusHealth Provider, Effective January 1, 2025, per DOH mandate, MetroPlusHealth will…
24 Dec
NY 1332 Waiver – Diabetic and Pregnant Members for QHP
Beginning January 1st, 2025, MetroPlusHealth’s Qualified Health Plan (QHP) members who report becoming pregnant, will have their cost-sharing for all…
23 Dec
ALL Children’s HCBS Providers
IMPACTED DATE: 10/24/24 IMPACTED PLANS: Medicaid and HIV SNP Effective 10/24/2024, per New State Department of Health (NYSDOH) mandated guidelines,…
23 Dec
Health Homes Serving Adults and/or Children
DATE: 11/12/2024 – DOH Memo Release IMPACTED PLANS: Medicaid, HIV SNPs, and HARP DOH has released guidance to notify that…
08 Dec
Mandated Rate Update: ACT Reimbursement and Billing Changes
DATES: 10/01/2023 (Retroactive) and January 1, 2025 (Prospective) RE: ALL BEHAVIORAL HEALTH PROVIDERS Effective 10/01/2023 (Retroactive), OMH has released guidance…
12 Nov
BEHAVIORAL HEALTH PROVIDERS RE: SCHOOL BASED MENTAL HEALTH CLINICS IN MENTAL HEALTH OUTPATIENT TREATMENT REHABILITATIVE SERVICES (MHOTRS) PROGRAM
Effective January 1, 2024, OMH has released guidance that is applicable to commercial reimbursement of School Based Mental Health Services…
22 Oct
Important Reminder: Model of Care Training due by 12/31/2024
Important Notice To All Our Providers Tuesday, December 31, 2024, is the deadline for you to complete the MANDATORY Annual…
08 Oct
Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services After the Coronavirus Disease 2019 Public Health Emergency
Comprehensive updated guidance regarding use of telehealth (including telephonic services) and billing guidance and criteria following the end of the…
23 Sep
2024 NYSDOH Breast Cancer Surgery Policy Letter
Research has consistently demonstrated that patients undergoing breast cancer surgery at high-volume facilities experience higher five-year survival rates. As a…
16 Sep
Payment Policy: E&M and Preventive Medicine Policy
LOB: Medicaid, HIV SNP, CHP, MetroPlus Gold, Goldcare I&II, QHP, Essential, HARP 1. POLICY DESCRIPTION: This payment policy provides guidelines…
Provider Resources
last updated: June 3, 2024
Already A Provider?
Talk To Us About Any Questions or Concerns
Monday–Friday | 8 a.m.–6 p.m. (ET)
