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
June 04, 2024
Update on the Change Healthcare (CHC) Outage: Claims Timely Filing Requirements to be Reinstated July 1, 2024
June 04, 2024
RE: NYS 2023-2024 BUDGET-SUBPART B, AMENDMENTS TO INCLUDE CRISIS RESIDENCE FACILITIES
April 01, 2024
Re: MetroPlusHealth’s Essential Plan (EP) Members Who Report Becoming Pregnant
March 13, 2024
IMPACTED PLANS: MEDICAID, AND HIV SNP NEW YORK STATE MEDICAID COVERAGE OF RESPIRATORY SYNCYTIAL VIRUS MONOCLONAL ANTIBODY (NIRSEVIMAB) FOR INFANTS
March 13, 2024
RE: Billing Guidance for Delivering Services in a Language Other Than English (LOE) Within MHOTRS Programs Impacted Plans: Medicaid, HARP, HIV SNP, AND MAP
March 13, 2024
APPROVAL OF THE NOVAVAX COVID 19 VACCINE
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…
16
Sep
Updated Foster Care Provider Education Letter
As a MetroPlusHealth network provider, you may find yourself in a position to provide trauma-informed care to Medicaid Managed Care…
12
Sep
Model of Care Webinar
> For more information | > Register for the Webinar | > Medicare Model Provider Training Deck
11
Sep
Managed Long Term Care (MLTC) Policy 24.01: Non-Emergency Medical Transportation and Social Adult Day Cares
Division of Health Plan Contracting and Oversight Date of Issuance: July 1, 2024 Effective Date: January 1, 2025 Purpose: The…
10
Sep
End of Change Healthcare Appeal Timeframe
As a result of the Change Healthcare cyber-attack dated February 21, 2024, MetroPlusHealth temporarily extended claim appeals for impacted claims…
28
Aug
Status Update of OASAS Part 822 Comprehensive Outpatient Treatment Program (COP)
TO: OASAS Part 822 Comprehensive Outpatient Programs (COP) Dear MetroPlusHealth Provider, Effective August 1, 2024 OASAS has directed programs to…
28
Aug
Status Update of OASAS Opioid Treatment Program (OTP) Bundles to Ambulatory Patient Groups (APG) Methodology
TO: ALL OASAS Opioid Treatment Programs Dear MetroPlusHealth Provider, Effective July 1 – Nov. 3, 2024, providers have the option…
22
Jul
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…
05
Jul
Expanded Eligibility for Community Health Worker Services
TO: ALL PROVIDERS Currently, MetroPlusHealth provides coverage of Community Health Worker (CHW) services to our Medicaid members during pregnancy and…
02
Jul
New York State Pharmacists Authorized to Dispense Hormonal Contraceptives Without Prescription
On March 19th, 2024, Governor Kathy Hochul authorized New York State pharmacists to dispense three types of self-administered hormonal contraception…
13
Jun
Concurrent Review Memo for Crisis Residence Facilities
TO: CRISIS RESIDENCE FACILITIES Effective May 3, 2024, per the NYS 2023-2024 Budget – Subpart B, modification for previously existing…
05
Jun
MetroPlusHealth is proud to announce our 2024 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…
04
Jun
Update on the Change Healthcare (CHC) Outage: Claims Timely Filing Requirements to be Reinstated July 1, 2024
As a result of the Change Healthcare cyberattack, MetroPlusHealth temporary extended claim appeals partially paid, fully paid, or denied, and…
04
Jun
RE: NYS 2023-2024 BUDGET-SUBPART B, AMENDMENTS TO INCLUDE CRISIS RESIDENCE FACILITIES
TO: METROPLUSHEALTH PARTICIPATING PROVIDERS – CRISIS RESIDENCE FACILITIES Effective May 3, 2024, per the NYS 2023-2024 Budget – Subpart B,…
09
Apr
NEW YORK STATE SEXUAL and ERECTILE DYSFUNCTION GUIDELINES: Medicaid Managed Care, Partnership in Care (PIC) HIV-SNP, Enhanced (HARP) Plan
NYS requirements for Sexual Dysfunction (SD) and Erectile Dysfunction (ED): In accordance with Chapter 645 of the Laws of 2005,…
01
Apr
Re: MetroPlusHealth’s Essential Plan (EP) Members Who Report Becoming Pregnant
Beginning April 1st, 2024, MetroPlusHealth’s Essential Plan (EP) members who report becoming pregnant, will have their copays for all services…
13
Mar
Rx Carveout
Beginning April 1, 2023, all Medicaid members enrolled in MetroPlusHealth Medicaid, Partnership In Care, and Enhanced (HARP) plans will receive…
13
Mar
Providers must comply with the DOH, OMH, OASAS, and OPWDD issued Billing Updates to applicable codes, modifiers, and Place of Service (POS) requirements, for Medical and Mental Health Services.
Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency Read Notice Here
13
Mar
PROVIDER SEMINAR: CANCER AND ENVIRONMENT
Wednesday, June 21st , 2023 | 9:30 AM – 5:00 PM Roy and Diana Vagelos Education Center Auditorium & via…
13
Mar
IMPORTANT REMINDER: Prescription Monitoring Program Registry
Effective August 27, 2013, most prescribers are required to consult the Prescription Monitoring Program (PMP) Registry when writing prescriptions for…
Provider Resources
last updated: June 3, 2024
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- Provider ResourcesWe’re committed to being the best possible partner to our 34,000+ providers like you. We’re here to help with anything you need.
Provider Resources
We’re committed to being the best possible partner to our 34,000+ providers like you. We’re here to help with anything you need.Login- Authorization Grids
- Provider Training
- Forms, Manual and Policies
- Pharmacy Resources
- Behavioral Health
- News
- ClaimsWe’ve made claims easy so you can quickly get back to caring for your patients.
CLAIMS SHORTCUTS
Claims
We’ve made claims easy so you can quickly get back to caring for your patients.CLAIMS SHORTCUTS
- Our NetworkWe partner with over 40 hospitals, 110 urgent care centers, 400 pharmacies, and 34,000+ providers like you to give patients everything they need.
Our Network
We partner with over 40 hospitals, 110 urgent care centers, 400 pharmacies, and 34,000+ providers like you to give patients everything they need. - Join Our NetworkHelp us keep our 713,000+ members healthy. We’re all about people, not profit.
Join Our Network
Help us keep our 713,000+ members healthy. We’re all about people, not profit.
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