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
October 16, 2026
Cultural Competency Training
October 14, 2026
MetroPlusHealth Earns 4-Star Medicare Rating for Second Consecutive Year
October 09, 2026
Updated Guidance: Electronic Billing Requirements for Direct Care Workers Impacted LOBs: Medicaid, HIV-SNP, HARP, MLTC, and MAP (UltraCare)
October 05, 2026
Introducing the New CPT Lookup Tool in the MetroPlusHealth Provider Portal
September 30, 2026
RE: Expansion of Covered Facial Prosthetics under Medicaid Vision Benefit
September 16, 2026
Pharmacy Prescription Specialty Drugs Prior Authorization Process Update – Effective 09/01/2026
August 18, 2026
NYSDOH Expansion of Remote Patient Monitoring (RPM) Delivered by Clinical Staff and for Prenatal/Postpartum Services
July 22, 2026
Policy Allowing Reimbursement of Emergency Ambulance Treatment in Place (TIP) Services
July 13, 2026
Ophelia is Now Part of MetroPlusHealth’s Telehealth Network
16
Oct
Cultural Competency Training
Dear MetroPlusHealth Providers, MetroPlusHealth reminds all participating providers and office staff who have regular and substantial contact with MetroPlusHealth members…
14
Oct
MetroPlusHealth Earns 4-Star Medicare Rating for Second Consecutive Year
NEW YORK, October 14, 2026 – MetroPlusHealth, New York City’s high-quality, affordable health plan, announced today that its Medicare Advantage…
09
Oct
Updated Guidance: Electronic Billing Requirements for Direct Care Workers Impacted LOBs: Medicaid, HIV-SNP, HARP, MLTC, and MAP (UltraCare)
The New York State Department of Health (NYS DOH) has updated its electronic billing guidance for Direct Care Workers. MetroPlusHealth…
05
Oct
Introducing the New CPT Lookup Tool in the MetroPlusHealth Provider Portal
RE: Introducing the New CPT Lookup Tool in the MetroPlusHealth Provider Portal Dear MetroPlusHealth Provider, MetroPlusHealth is pleased to announce…
30
Sep
RE: Expansion of Covered Facial Prosthetics under Medicaid Vision Benefit
Dear MetroPlusHealth Provider, Facial prosthetics are custom-made external devices, typically constructed from medical-grade materials, designed to restore the appearance and/or…
16
Sep
Pharmacy Prescription Specialty Drugs Prior Authorization Process Update – Effective 09/01/2026
TO: All Providers Dear MetroPlusHealth Provider, Effective as of September 1, 2026, Prior Authorization (PA) requests for Pharmacy Prescription Specialty…
18
Aug
NYSDOH Expansion of Remote Patient Monitoring (RPM) Delivered by Clinical Staff and for Prenatal/Postpartum Services
TO: All Providers 8/15/2026 Dear MetroPlusHealth Providers, Effective January 1, 2026 onwards, MetroPlusHealth has implemented coverage and reimbursement of claims…
22
Jul
Policy Allowing Reimbursement of Emergency Ambulance Treatment in Place (TIP) Services
TO: Ambulance Service Providers DATE: 7/8/2026 Dear MetroPlusHealth Provider, To comply with New York State reimbursement policy guidelines for dates…
13
Jul
Ophelia is Now Part of MetroPlusHealth’s Telehealth Network
MetroPlusHealth is proud to announce that Ophelia is now part of our telehealth network, expanding access to evidence-based, compassionate care…
10
Jul
NYS Medicaid Update for Child Abuse Pediatrics Reimbursement and ABP Certification Requirement
TO: All Providers Dear Valued MetroPlusHealth Provider, Per New York State Medicaid Update, effective since December 1, 2025, MetroPlusHealth will…
26
Jun
New York State Medicaid Perinatal Care Standards 2026 Update
Effective as of February 1st, 2026 Dear MetroPlusHealth Provider, New York State Medicaid has recently updated Perinatal Care Standards to…
26
Jun
New York State Department of Health (DOH) Released Updated Billing Guidance for the New York State Patient Centered Medical Home (NYS PCMH) Program
The New York State Department of Health (DOH) released updated billing guidance for the New York State Patient Centered Medical…
16
Jun
Medical Physician Administered Drug Prior Authorization Grids
Dear MetroPlusHealth Provider, We are committed to streamlining the authorization process for our provider partners. Our Provider Authorizations page offers…
15
Jun
RE: Change to Prior Authorization Procedures for Select Services
Dear MetroPlusHealth Provider, As of July 15, 2026, the services below will change from requiring prior authorization to periodic retrospective…
12
Jun
Important Update – Revised Notice to Providers Regarding Think Cultural E-Learning Site
Dear MetroPlusHealth Provider, As of February 15, 2026, the U.S. Department of Health & Human Services’ Think Cultural Health e-learning…
01
Jun
Important Update – Referral Requirements Waived for Gold Members (NYC Employees)
Dear MetroPlusHealth Providers, We are pleased to share an important update regarding the Gold Plan designed for our NYC workforce…
01
Jun
National Drug Code (NDC) Requirements for Accurate Claims Processing Effective 7/1/2026
Dear Provider, This requirement is pursuant to Section 6002 of the Deficit Reduction Act of 2005, codified at 42 USC…
05
May
Patient Access and Availability Survey
Dear MetroPlusHealth Providers and Office Staff, MetroPlusHealth will be conducting its quarterly Patient Access and Availability Survey beginning on or…
30
Apr
2026 NYSDOH Breast Cancer Surgery Policy Letter
We are writing to share important information regarding a policy update from the New York State (NYS) Department of Health…
30
Mar
New York State Medicaid Coverage of MRI Guided High Intensity Focused Ultrasound for Essential Tremor
TO: All Providers Effective January 1, 2026, per New York State (NYS) Medicaid guidelines, MetroPlusHealth will cover Magnetic Resonance Image…
24
Mar
Breast Cancer Screening Guidelines (Age Criteria Update)
Dear Valued MetroPlusHealth Provider, MetroPlusHealth is committed to keeping our provider network informed on important clinical changes. This notice is…
20
Mar
Reminder: Status Update of OASAS Opioid Treatment Program (OTP) Bundles to Ambulatory Patient Groups (APG) Methodology
TO: ALL OASAS Opioid Treatment Programs Reminder: Status Update of OASAS Opioid Treatment Program (OTP) Bundles to Ambulatory Patient Groups…
09
Mar
MetroPlusHealth – Important Reminder: PCP Replacement for Provider Terminations
Dear Valued Provider, We’d like to share a friendly reminder about the importance of notifying us at least 30 days…
27
Feb
New York State Medicaid Coverage of Tumor Treatment Field Therapy
TO: All Providers Effective 12/1/25, MetroPlusHealth will cover the provision of Tumor Treatment Field Therapy (TTFT) when billed under HCPCS…
26
Feb
Additional Enhanced Rates for Evidence Based Practices (EBPs) within Children and Family Treatment and Support Services (CFTSS)
TO: Children and Family Treatment Support Services (CFTSS) Provider Agencies (Retro) Effective January 1, 2025, the New York State (NYS)…
Provider Support
last updated: June 3, 2024
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