Our goal is to give our Providers help finding and managing day-to-day needs. Please contact Provider Services at 1-800-303-9626 (TTY: 711) or Medicare at 1-866-986-0356 if you need help or have questions.
Register or get directed to online trainings through the calendar.
PROVIDER EDUCATION AND TRAINING |
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- Monthly Education Training Calendar
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NOTICE TO OUR PROVIDERS REGARDING New York State Medicaid’s reimbursement policy for administration of COVID-19 vaccines
The New York State Department of Health has updated the coverage policy and billing guidance document regarding New York State Medicaid’s reimbursement policy for the administration of COVID-19 vaccines. This guidance can be found on the COVID-19 Guidance for Medicaid Providers (ny.gov) webpage, which is updated regularly.
HELP PATIENTS PREVENT DIABETES WITH LIFESTYLE TIPS
Here are some lifestyle steps your patients can take to help reduce blood sugar levels and prevent diabetes:
Shed weight.
Losing weight can feel overwhelming for many patients. But it doesn’t take much to help improve their health. Shedding just 7% of body weight has been proven to lower the risk of diabetes. Move more.
Aim to get 30 minutes of exercise on most days — or 150 minutes a week — to help ward off chronic disease. Tweak diet choices Limit added sugars and choose whole foods instead of processed foods like chips, boxed dinners, and fast food. Non-starchy vegetables like carrots, broccoli, and spinach as well as lean meats and fish can help keep blood sugar stable.
Prioritize sleep.
Patients should aim for seven to eight hours of quality sleep every night. Good sleep can lower the risk of insulin resistance, which can lead to high blood glucose levels.
Follow up.
Follow up with patients yearly to check blood sugar levels and ensure they are taking proactive steps to prevent diabetes. It’s estimated that 80% of people with prediabetes are unaware they have it.
DIABETES RESOURCES
Patients who participate in American Diabetes Association diabetes self-management education and support (DSMES) are more likely to manage their health and take medicines as prescribed. To learn more, click here.
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.
PROVIDER SEMINAR: CANCER AND ENVIRONMENT
Wednesday, June 21st , 2023 | 9:30 AM – 5:00 PM
Roy and Diana Vagelos Education Center Auditorium & via Zoom
Join the Herbert Irving Comprehensive Cancer Center at Columbia University Irving Medical Center and the Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine for a one-day CME event on the state of the science of environmental carcinogenesis and the role physicians, nurses, community leaders, and public health practitioners play in engaging on environmental chemicals and cancer risk reduction.
For more information.
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 Coronavirus Disease 2019 Public Health Emergency on May 11,2023, released by the New York State Department of Health, can be found here.
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 More
IMPORTANT MESSAGE TO OUR PROVIDERS: PCP IN-OFFICE NON-ALLOWABLE SERVICES
Effective April 15, 2022
The Primary Care Provider (PCP) In-Office Non-allowable services list is a compilation of procedure codes MetroPlusHealth deems non-allowable for reimbursement to our Network PCPs (Family Practice, Internal Medicine, Pediatrics, Geriatrics and Adolescent Medicine). MetroPlusHealth PCP non-allowable in-office services list will go into effect on April 15th, 2022. Click here to learn more and for the list of impacted codes.
IMPORTANT REMINDER TO OUR PROVIDERS REGARDING OUR NATIONAL DRUG CODE (NDC) REQUIREMENT POLICY, PROFESSIONAL AND FACILITY
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.
IMPORTANT NOTICE TO OUR PEDIATRIC PRIMARY CARE PROVIDERS REGARDING 2023 ENHANCED CHILDREN’S BENEFITS:
MetroPlusHealth has been ramping up for the expansion of services that will become available to children and youth in 2023. Learn more here about new benefits and services coming in 2023.
IMPORTANT NOTICE TO OUR APPLIED BEHAVIORAL ANALYSIS (ABA) PROVIDERS REGARDING 2023 ABA BENEFIT CHANGES
MetroPlusHealth has been ramping up for the expansion of Applied Behavior Analysis Services to eligible Medicaid members diagnosed with autism spectrum disorder. Services will become available January 1, 2023, for those members under 21 years of age. Learn more here about new benefits and services coming in 2023.
IMPORTANT NOTICE: THE PROVIDER DUE DATE FOR COMPLETION OF THE MODEL OF CARE TRAINING IS DECEMEBER 31, 2023. CLICK HERE TO ACCESS THE ONLINE TRAINING.
You can access the digital attestation form here.
IMPORTANT MESSAGE ANNOUNCING AN END OF YEAR BONUS PAYMENT FOR OUR PROVIDERS IN ASSISTING MEMBERS TO OBTAIN THEIR KEY WELLNESS TESTS/VISITS.
This incentive is separate from our Pay for Performance (P4P) Program. Learn more here.
IMPORTANT NOTICE TO 1915(c) CHILDREN’S WAIVER RESPITE HCBS PROVIDERS:
The New York State Department of Health is evaluating various policy flexibilities allowed during the COVID-19 Public Health Emergency (PHE) and determining which flexibilities will be ending and which ones will be extended (temporarily/permanently).
Effective January 1, 2023, the Children’s Respite Services flexibility will end and providers are required to revert to the original guidance provided in the HCBS Manual. Read the guidance here.
IMPORTANT NOTICE: PHARMACY BILLING GUIDANCE EXCEPTIONS FOR NON-ENROLLED PRESCRIBERS
The New York State (NYS) Medicaid program requires enrollment of all licensed prescribers and pharmacies who serve Medicaid members, including prescribing practitioners identified on pharmacy claims per the Centers for Medicare and Medicaid Services (CMS) and federal regulations. However, under the Medicaid Provider Enrollment Compendium (MPEC) found here: https://www.medicaid.gov/medicaid/program-integrity/affordable-care-act-program-integrity-provisions/index.html, there are two exceptions to the provider enrollment requirement that are allowed. Learn more here.
IMPORTANT NOTICE REGARDING PT AND OT VISITS
Effective January 1, 2023, the number of visits allowed without prior authorization for both Physical Therapy (PT) and Occupational Therapy (OT) will change. Ten (10) visits will be allowed without prior authorization, inclusive of the initial evaluation.
Effective January 1, 2023, all Speech Therapy and Chiropractic Care will require prior authorization. There will be no visits allowed without prior authorization.
Overall benefits allowed vary by Line of Business (LOB), so it is important to verify both LOB and eligibility prior to rendering services. Click here to learn more about facilitating review when requesting visits for PT or OT.