Integra mltc provider manual. Claim Submission/ERA/EFT Info.

Integra mltc provider manual \(http Sources: 2017-2021 MLTC Model Contracts, 1115 Waiver, and NYS Partnership for Long Term Care New Assessment for MLTC Services: Chapter 56 of the Laws of 2020 authorized the Department of Health (Department) to contract with an entity to conduct an independent assessment process for individuals seeking Community Based Long Term Services and full network of providers and strong ties with community and healthcare groups. +1 (401) 430-2000; Find A Provider; About; Integra providers and staff can more effectively target patients for education, intervene to improve health and wellness, track compliance with critical Provider Manual ; Provider FAQs ; See All ; Provider Resources . Of the 36,295 members that transferred from Integra to Anthem HP, a standard size random sample of 50 members were selected for a case review. (800) 597-3380 Mainstream AA 04004537 Healthplus HP LLC (800) 454-3730 HARP AC 03114514 Catholic MLTC - ArchCare Senior Life (866) 263-9083 Integra MLTC, Inc. These teams work in close partnership with members, their families, and health care providers to ensure their long-term care needs are met. Provider Business Mailing Address: Integra MLTC, Inc. is a health care organization in Brooklyn with Health Maintenance Organization - Click to see all Health Maintenance Organization providers in Brooklyn and other nearby locations listed as their primary medical specialization. Empire Managed Long-Term Care is a managed long-term care plan for Medicaid-eligible people who: In the event of a material change to the Provider Manual, Archcare Community Life will make all reasonable efforts to notify you in advance of such changes through Provider Educational Series, Provider Newsletters, and other mailings. If you cannot find your provider in this directory, please call Member Services to see if we have recently added him/her to our network. Jul 22, 2024 · Plan Code Plan ID# PCP Provider Name Telephone Number Plan Type 92 00894519 Metroplus Health Plan, Inc. Your username is your full email address but Since 2005, Integra has been recognized as the thought leader on DMEPOS services. Gender: Provider License Number If Given: NPI Information: NPI: 1841615630: Entity Type (Individual or Organization): 2-org: Enumeration Date: 3/3/2014. We’re dedicated to improving the quality of life of each member by providing the best and most reliable We are pleased to be able to offer this manual to CPHL’s providers. Info for Providers; Find a Doctor or Hospital; Contact; Search healthfirst. org Compliance/Anti-Fraud Telephone Online (855) 252-7606 www. 006 AL he tale . The partially-capitated managed long-term care plans provide long-term care services, ancillary Centers Plan for Managed Long Term Care Plan or MLTC . Provider Manual ; Provider FAQs ; See All ; Provider Resources . Anthem provider manuals provide key administrative information, details regarding programs that include the utilization management program and case management programs, quality standards for provider participation, guidelines for claims and appeals, and more. INFORMATION FOR ALL PROVIDERS . Providers can access the most current Provider Manual at . Or click on your Table of Contents • Provider Portal • Helpful Links Introduction VNS Health is pleased to welcome you to our health plan provider network. We’re here to help with anything you need. 2 Plans services by IntegraNet Health; 3 CONTACT INFORMATION; 3. Ashley Caldwell's Phone Number and Email. 908. IT 03475427 Integra MLTC, Inc (855) 661-0002 TTY (711) Partial LTC IX 01865329 Independence Care Systems (877) 427-2525 TTY (711) To search our provider network for our Managed Long-Term Care Plans, please use our Find a Doctor search tool. nascentiahealthplus. Billing Codes and Modifiers. NEW YORK STATE . Emergency Care 50 . Starting March 20, 2025, Healthfirst will add prior authorization requirements for selected medical services. Click ‘My Money’ in the main menu and select ‘Create Reserve Fund’ from the benefits and services, help you find a provider, schedule a medical appointment, replace a lost ID card, or send you copies of t he Member Handbook and/or Provider Directory. Voluntary Disenrollment 52 Integra Portal Need Help? You can reserve funds for providers through the portal and support coordinators and providers can then view these reserved funds. These services, such as home care or adult day care, are provided through managed long-term care plans that are approved by the New York State Department Manager of Provider Network Devepment and Relations at Integra MLTC, Inc. MLTC Tip Sheet- Chinese version. (800) 597-3380 Mainstream AA 04004537 Anthem (800) 454-3730 HARP MP 03466906 MetroPlus MLTC (855) 355-6582 TTY (800) 881-2812 Partial LTC MR 00477023 Excellus (800) 920-8889 Mainstream Jan 31, 2021 · Provider Manual Empire BlueCross BlueShield HealthPlus Essential Plan . Information for All Providers – Managed Care Information Version 2013-5 September 18, 2013 2 of 5 Prepaid Capitation Plans (PCP) Key: IT 03475427 Integra MLTC Inc. Explore resources that help healthcare professionals care for Empire Blue members. d/b/a RiverSpring Health Plans PO Box 211465 Eagan, MN 55121. Provider manual SHP manual. Providers may verify member eligibility, review authorizations, set up electronic payments, and download Explanation of Payments through our Provider Portal: riverspring. Once again, FIDA and MLTC will continue to be managed by MetroPlus directly. Claims Customer Service: Access and download the Provider Manual. Oct 1, 2024 · Here are some Frequently Asked Questions by Providers to assist in the transition. MolinaHealthcare. indd 1 29/12/22 3:59 AM. © 2025 - Empire BlueCross BlueShieldEmpire PDF-1. All the required fields are marked with an asterisk(*) Empire BlueCross BlueShield HealthPlus MLTC Provider Portal. The practitioner's main practice location is at 1981 Marcus Ave, New Hyde Park, NY 11042-2060; Oct 17, 2023 · have the same meaning as “Health Plan” in your Agreement. 1 Reporting Changes in Address and/or Practice Status; Providers must submit the applicable, completed and legible forms to: ElderServe Health, Inc. View Contact Info for Free. Out-of-Network Care 50 . MLTC Plan Member Referral Form. Providers may also obtain information about the provider Provider Manual (Provider Handbook) Senior Whole Health by Molina Healthcare (Senior Whole Health or Senior Whole Health) Medicaid Managed Long Term Care Plan 2023 Last Updated: 0 Empire BlueCross BlueShield HealthPlus MLTC Provider Portal. 1 About IntegraNet Health; 1. This Provider Manual is intended to be used as a communication tool and reference guide for providers and their office staff. MetroPlusHealth Plan’s service area is: • Bronx • Brooklyn • Manhattan • Queens • Staten Island . All claims must be submitted to Hamaspik Inc. \(http Provider Manual Table of Contents . Claim Submission/ERA/EFT Info. Catholic MLTC - ArchCare Senior Life (866) 263-9083 TTY (800) 662-1220 LTC Pace AG Utilization Data Reviewer · Dynamic individual with experience working as a Health Care Professional. These services, such as home care or adult day care, are provided through managed long-term care plans that are approved by the New York State Department of Health. In fact, VNS Find out what works well at Integra MLTC from the people who know best. Table of Contents. Mar 1, 2023 · Please call Provider Services at 1-800-450-8753 with any suggestions, comments or questions you may have. Get the inside scoop on jobs, salaries, top office locations, and CEO insights. Uncover why Integra MLTC is the best company for you. Claim Review Request Form. Providers may also obtain information about the provider dispute process by calling the CPHL Claims department at 844-292-4211, Option 2 (Monday through Friday, 9AM to 5PM). See below for our most requested forms. Reminder: WellCare MLTC and LTSS members will transition to Fidelis Care MLTC and LTSS programs . CLAIMS AND PAYMENT. Medical policies address the medical necessity of new services or procedures and new applications of existing services or procedures. a Partial CPHL informs providers about the dispute resolution process through the Provider Manual, provider orientation, and the CPHL website. Find Out if Yaroslav is a Potential MetroPlusHealth MLTC participating providers is included at the back of the directory. VNS Health MLTC is a Medicaid plan designed for New Yorkers who want to remain in their own homes and communities but need help with daily activities such as bathing, dressing, walking, and preparing food. Wellcare By Fidelis Care Medicare Advantage/ Dual Advantage Tip Sheet. Transportation Provider 49 . To make a referral to CHOICE MLTC*: Phone: 1-888-735-8912 Fax: 1-212-714-2938 Email: MLTC_Pre-Enrollment_Team@vnsny. have the same meaning as “Health Plan” in your Agreement. 5 days ago · Provider manuals and quick reference guides. 12/15/2023 3:47 PM. 8/5/2022 9:34 PM. Vision Provider 49 . Practice location: 1981 MARCUS AVE NEW HYDE PARK NY 11042-2060 Managed long-term care (MLTC) is a system that streamlines the delivery of long-term services to people who are chronically ill or disabled and who wish to stay in their homes and communities. Anthem Provider sites Provider Manuals. , a provider established in New Hyde Park, New York operating as a Health Maintenance Organization. To request access to our provider portal, you will need to send an email to Providerportalrequest@elderservehealth. \(http The average annual Integra Mltc Inc Salary for Director, Provider Network Development is estimated to be approximately $175,861 per year. View Tamara Suyazov's business profile as Provider Claims Representative at Integra MLTC. 1 About Medicare Advantage; 2. Find contact's direct phone number, email address, work history, and more. Provider Manual does not fully address, please call . Visit EmpireBlue. Email. Claims Customer Service: Mar 3, 2014 · This webpage represents 1841615630 NPI record. Compare pay for popular roles and read about the team’s work-life balance. The insurer announced plans to acquire Integra, a long-term care plan, in November. Ashley Caldwell is a Provider, Relations Network Specialist at Integra MLTC based in Lake Success, New York. (855) 661-0002 Partial LTC IX 01865329 Independent Care Systems (212) 584-2500 Partial LTC KP 01617894 Amerigroup NY, LLC (800) 454-3730 Mainstream KX 02644562 Amerigroup Community Connections (212) 563-5570 Partial LTC M3 01825947 Sources: 2017-2021 MLTC Model Contracts, 1115 Waiver, and NYS Partnership for Long Term Care New Assessment for MLTC Services: Chapter 56 of the Laws of 2020 authorized the Department of Health (Department) to contract with an entity to conduct an independent assessment process for individuals seeking Community Based Long Term Services and Manager, Provider Relations at Integra MLTC. Jan 18, 2023 · The MLTC provider manual is your guide to this partnership. 2701 Emmons Ave Brooklyn, NY 11235-2209 - Directions available below Integra MLTC, Inc. The plan will bring more than 40,000 About INTEGRA MLTC INC. The majority pay is between $159,287 to $190,374 per year. • To view the full list of prior authorization requirements, go to the Forms page under Provider Services on the MetroPlus website. Prior Authorization Guidelines for Select CPT and HCPCS Codes Effective March 2025. In accordance with the Medicaid Managed Long Term Care Partial Capitation Model DOH Medicaid Update Website Provides up-to-date changes that may affect your participation in the Medicaid Program. Others are generic. WE’RE NEW YORK CITY. hotline-services. Non-Discrimination Provider must not differentiate or discriminate in accepting and treating patients on Oct 7, 2022 · • To view the full list of prior authorization requirements, go to the Forms page under Provider Services on the MetroPlus website. •Print and electronic copies of the Empire provider manual are available to all providers to 3 days ago · Since 2005, Integra has been recognized as the thought leader on DMEPOS services. \(http Manager of Provider Network Devepment and Relations at Integra MLTC, Inc. All the required fields are marked with an asterisk(*) Jan 6, 2025 · If your patient is an Integra member and needs access to additional services that can help them stay healthy, Integra is here to support them. Guidance for comprehensive health insurance policy forms. Additional copies of the manual are available on request, and you will be notified regarding any changes through electronic Jul 2, 2024 · Anthem Provider sites 1 day ago · Managed Long-Term Care (MLTC) provides services and support to NY Anthem members with long-lasting health problems or disabilities. Last Update. Information for All Providers IT 03475427 Integra MLTC Inc. Veterans Homes 49 . 1 OVERVIEW; 1. 104. We use cookies on our Dear Provider, Integra Partners will begin managing DME Utilization Management (UM) services for MetroPlus Health Plan (MetroPlus) beginning 12/1/2018. Dental Provider 49 . MLTC services include help with everyday tasks like bathing, dressing, getting around the house, making meals, or doing household chores. Section Provider Manual . (NYSE: ANTM) today announced the completion of its acquisition of Integra Managed Care, a Managed Long-Term Care Plan in New York that he Anthem's plan to acquire Integra Managed Care was initially announced in November 2021. For a complete list of DME codes that • For MLTC claims, if VillageCareMAX is not primary, submit the claim within 90 days of the date on the Explanation of Payment (EOP)/Remittance » Integra Partners Tel: 888-729-8818Mon - Fri, 8 am - 8 pm. Rather, CHOICE is controlled solely by its direct and indirect sole corporate members, which are charitable nonprofit corporations. Highly motivated, easily adaptable and substantial experience in Information Technology Provider, Relations Network Specialist at Integra MLTC. x. ("Integra") is a Medicaid Managed Long Term Care Plan that serves Medicaid beneficiaries in need of long term supportive services to help them live in their home and community. Please note this provider manual will be amended as our operational policies change. : Ordering Information Contact information you can use to order hard (paper Information for All Providers – Managed Care Information . The financial terms of the completed transaction were not disclosed. What is the average salary for a Director, Provider Network Development at Integra Mltc Inc in the United States? Based on our data, it appears Participating Providers in Anthem Network 48 . required to comply with Senior Whole Health’s MLTC Provider Manual and its policies and procedures for matters such as claims, grievances, quality improvement, utilization Provider, Relations Network Specialist at Integra MLTC. When will I be listed in We’re committed to supporting you in providing quality care and services to the members in our network. MLTC login. That’s why we work hard to provide you with the resources you need to help care for our members. com. 3 days ago · Since 2005, Integra has been recognized as the thought leader on DMEPOS services. This webpage represents 1841615630 NPI record. It contains basic information about how to work with CPHL as well as how to refer Members to specific services. a***@integraplan. Log in to Provider Access Online, access authorization grids, browse manuals and forms, download tip sheets, and learn how to join our Provider Network. In such cases, the most recently published information shall supersede all Managed long-term care (MLTC) is additional details, please see the VillageCareMAX Provider Manual, Section 10. username. The first time you login, you may be asked to recreate your account in order to access the upgraded portal. Jan 1, 2024 · Provider manual •The provider manual offers detailed information about Anthem policies and procedures, care management, FWA, and other important areas. We’re dedicated to improving the quality of life of each member by providing the best and most reliable healthcare to the communities we serve. It contains useful information about the Empire program and guidance regarding important regulations, policies, and procedures. Our extensive community outreach efforts were recognized by the American Association of Health Plan Code Plan ID# PCP Provider Name Telephone Number Plan Type 82 00477156 Affinity Health Plan, Inc. Health (1 days ago) Empire MLTC Provider Manual Page 5 Introduction Empire BlueCross BlueShield HealthPlus (Empire) Managed Long-Term Care (MLTC) Plan, is a New York State-approved Managed Post Acquisition Reporting of Member Service Authorizations from Integra MLTC, Inc. © 2025 - Empire BlueCross BlueShieldEmpire If your patient is an Integra member and needs access to additional services that can help them stay healthy, Integra is here to support them. org. , practice location address at 1981 MARCUS AVE NEW HYDE PARK, NY, 11042-2060. Box 445 Elmsford, NY 10523 *If emailing, send all PHI via (MLTC)/Medicaid Advantage Plus (MAP) services to over 400,000 members and are one of the largest health plans in New York City. Medication Prior Authorization Form. (Plan). Electronic Claim Submission and Payment CPHL informs providers about the dispute resolution process through the Provider Manual, provider orientation, and the CPHL website. 5 %öäüß 1 0 obj /Lang /MarkInfo /Marked true >> /Metadata 2 0 R /Outlines 3 0 R /PageLayout /OneColumn /Pages 4 0 R /StructTreeRoot 5 0 R /Type /Catalog >> endobj 6 0 obj >> endobj 2 0 obj /Length 4327 /Subtype /XML /Type /Metadata >> stream 2021-05-27T11:38:45-04:00 2020-09-29T18:17:45-04:00 2021-05-27T11:38:45-04:00 Acrobat PDFMaker benefits and services, help you find a provider, schedule a medical appointment, replace a lost ID card, or send you copies of t he Member Handbook and/or Provider Directory. 1-855-456-9126. 1981 Marcus Avenue, Suite 100 Lake Success, New York 11042 Re: Final Audit Report Audit #: 20-5492 Provider ID #: 03475427 Dear This is the Office of the Medicaid Inspector General's (OMIG) Final Audit Report for Integra MLTC, Inc. \(http May 30, 2024 · have the same meaning as “Health Plan” in your Agreement. org) Not a Covered Benefit: No individuals have an ownership or controlling interest in VNSNY CHOICE (CHOICE) as described in 42 C. INTEGRA MLTC INC. Integra will assume responsibility for utilization management determination, prior authorizations and appeals for all lines of business, except for FIDA and MLTC. It provides detailed information to answer many of Plan Code Plan ID# PCP Provider Name Telephone Number Plan Type 82 00477156 Affinity Health Plan, Inc. · Education: Columbia University, Teachers College · Location: Brooklyn · 414 Information for All Providers – Managed Care Information NEW YORK STATE MEDICAID PROGRAM INFORMATION FOR ALL PROVIDERS MANAGED CARE INFORMATION IT 03475427 Integra MLTC, Partial Cap (855) 661-0002 TTY (711) Partial LTC KP 01617894 Healthplus HP, LLC (800) 454-3730 Mainstream KX 02644562 Healthplus HP, LLC (866) 805 have the same meaning as “Health Plan” in your Agreement. Contact Number (***) ***-**** Engage via Regulatory news and educational resources for Fidelis Care providers, carrying out services in New York State. As part of your benefits plan with INTEGRA, you have access to your medical claims history and explanation of benefits (EOBs) online! INTEGRA has upgraded our Employee and Provider portal. The healthcare provider is registered in the NPI registry with number 1457981979 assigned on January 2020. Box 22008 Tampa, FL 33622-2008. com Grievance and Appeals Telephone Fax (888) 477-4663 (315) 870-7788 have the same meaning as “Health Plan” in your Agreement. Plans. Whether you’re a provider looking to work with more health plans, an insurer looking to provide smarter access to your membership, or a member searching for local, quality care you can trust, Integra provides unparalleled access to a greater network. MCG Cite Guideline Tool Quick The 1457981979 NPI number is assigned to the healthcare provider INTEGRA MLTC INC. Out of network providers must submit claims within 120 days from date of service. We value you as a member and look forward to working with you to provide quality services. Clinical UM guidelines focus on detailed Returning User Login. \(http For the New York Managed Long-Term Care (MLTC) program, Aetna Better Health in New York serves the following counties: Nassau County Suffolk County Kings Queens New York Bronx . MLTC Tip Sheet. This page provides the complete NPI Profile along with additional information for Integra Mltc Inc. Medicare Covered Services 51 . The Provider Manual is customarily updated annually but may be updated more frequently as needed. Together, we can arrange for and provide an integrated system of coordinated, efficient and quality care for our members and your patients. MetroPlus will be responsible for addressing grievances for all Utilization Management Supervisor @ Integra MLTC | Masters in Management · With over 9 years of professional experience in the healthcare management sector, my core competencies lie in policy Based on our data, it appears that the optimal compensation range for a Director, Provider Relations at Integra Mltc Inc is between $159,287 and $190,374, with an average salary of $175,861. Mar 1, 2023 · Term Care (MLTC)/Medicaid Advantage Plus (MAP) services to over 440,000 members and are one of the largest health plans in New York City. Entity Type: Organization: Most Important Dates: Provider Enumeration To search our provider network for our Managed Long-Term Care Plans, please use our Find a Doctor search tool. Short-term stay is covered under MLTC. . The plan will Provider Search - VNS Health MLTC (vnshealthplans. Provider Manual. , Partial Capitation membership effective December 1, 2022, and agreed to offer 120 days continuity of care to Integra members. We’re committed to being the best possible partner to our 34,000+ providers like you. Reminder: WellCare MLTC and LTSS members will transition to Fidelis Care MLTC and LTSS programs Providers may have multiple taxonomy codes and should only include the taxonomy code that applies to the services performed and reported on the claim submission. Know your rights and protections against surprise medical bills! When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. (800) 597-3380 Mainstream AA 04004537 Healthplus HP LLC (800) 454-3730 HARP AC 03114514 Catholic MLTC - ArchCare Senior Life (866) 263-9083 have the same meaning as “Health Plan” in your Agreement. Hospitalization 51 . Mar 17, 2023 · additional details, please see the VillageCareMAX Provider Manual, Section 10. Integra Mltc Inc. In its first quarter (Q1) 2022 earnings Find out what works well at Integra MLTC from the people who know best. Provider name: INTEGRA MLTC INC. Please keep this manual as a reference and contact us at (877) 353-9819 should you have any questions. Some forms are specific to the type of plan you have. , practice location address at 2701 EMMONS AVE BROOKLYN, NY, 11235-2209. Table of Contents • Provider Portal • Helpful Links Introduction VNS Health is pleased to welcome you to our health plan provider network. FQ 03870073 Integra FIDA Plan – Closed 1/1/16 FIDA FR 03864793 Metroplus FIDA Plan (844) 288-3432 TTY (711) FIDA IT 03475427 Integra MLTC, Inc (855) 661-0002 TTY (711) Partial LTC Welcome AgeWell MLTC Providers to Senior Whole Health! Date 10/1/2022. We’re dedicated to improving the quality of life of each member by providing the best and most reliable Nov 20, 2023 · can explain benefits and services, help you find a provider, schedule a medical appointment, replace a lost ID card, or send you copies of the Member Handbook and/or Provider Directory. Contact Number Integra Mltc, Inc - Health Maintenance Organization in New Hyde Park, NY at 1981 Marcus Ave - ☎ (855) 800-4683 Integra Mltc, Inc has been registered with the National Provider Identifier database since January 23, 2020 and its NPI number is 1457981979. Member Forms. Ivette Gonzalez is a Manager, Provider Relations at Integra Managed Care based in Lake Success, New York. 30269HBMDNYEN_MLTC Provider Manual. Managed long-term care (MLTC) is a system that streamlines the delivery of long-term services to people who are chronically ill or disabled and who wish to stay in their homes and communities. These helpful manuals will give you and your staff easy access to the information you need to run your practice and provide quality care to Healthfirst members. 1. General Essential Plan, MarketPlace Plans, SHOP Plans, Gold/GoldCare Plans. Important Contact Information. com . username Updates and changes to this manual will be posted to the website as they become available. 82 00477156 Affinity Health Plan, Inc. Provider Directory. com today! Provider Manual Table of Contents . Empire MLTC Plan is a 5-Star rated MLTC plan, according to the New York Department of Health’s 2019 Managed Long-Term Care Consumer Guide for NYC. , practice location address at 2701 EMMONS AVE BROOKLYN, NY, 11235 Dec 11, 2023 · MLTC organizations are certified to enroll in more than one plan type, and these are considered separate plans. ppi. 5185 Requests for MLTC only: Fax: 212. Sep 23, 2022 · •The provider manual offers detailed information about Empire policies and procedures, care management, FWA, and other important areas. (800) 597-3380 Mainstream AA 04004537 Amerigroup New York LLC (800) 454-3730 HARP AC 03114514 . A designated care manager will help you find the services you need. Electronic Submission: Payor ID 31626. Engage via Email. (MLTC) Download Download . Provider User Guides . i***@integraplan. Ivette Gonzalez's Phone Number and Email. Social Adult Day Care (SADC): structured, comprehensive program Plan Code Plan ID # PCP Provider Name Telephone Number Plan Type 82 00477156 Affinity Health Plan, Inc. Corrected Claim Tip Sheet. Utilization Data Reviewer · Dynamic individual with experience working as a Health Care Professional. Dear Provider. Paper Claims: Nascentia Health Options P. Join Our Network; Find a Doctor or Hospital; Anthem HP, a Partial Capitation MLTC plan in New York State, acquired the Integra MLTC Inc. +1 (401) 430-2000; Find A Provider; About; Integra providers and staff can more effectively target patients for education, intervene to improve health and wellness, track compliance with critical Returning User Login. Some Provider Manual (Provider Handbook) Senior Whole Health by Molina Healthcare (Senior Whole Health or Senior Whole Health) Medicaid Managed Long Term Care Plan 2023 Last Updated: 0 Regulatory news and educational resources for Fidelis Care providers, carrying out services in New York State. is registered in Brooklyn, NY, Integra Mltc Inc. is a Health Maintenance Organization (organization) practicing in New Hyde Park, New York. To schedule an appointment, please call (855) 800-4683. Long-term stay is covered under Medicaid Fee for Service (FFS). MEDICAID PROGRAM . The practitioner's primary Senior Whole Health offers a Managed Long-Term Care (MLTC) Plan for individuals with New York State Medicaid. org with the following information: National Provider Identifier: 1457981979. When you create a secure account, you get access to: Register for an Account The provider portal offers [] Since 2005, Integra has been recognized as the thought leader on DMEPOS services. For a complete list of DME codes that require prior authorization, please see Appendix 10 in the Provider Manual. Prior Authorization Request Form. The MLTC program provides Members with services that allow them to The Provider Manual is a supplemental document to, and an extension of, your contract with Senior Whole Health. F. Search for In-Network Providers . Book an Appointment. Email . Click the button below to log into the application. org Claims Appeals Formal claims appeals should be mailed with all VNSNY CHOICE supporting documentation to CHOICE Grievance & Appeals MLTC Grievance and Appeals P. Highly motivated, easily adaptable and substantial experience in Information Technology Providers may have multiple taxonomy codes and should only include the taxonomy code that applies to the services performed and reported on the claim submission. At Senior Whole Health of New York, we value you as a provider in our network. For all questions, providers should contact 800-303-9626 or your Provider Relations Representative at 212-908-3636. Medical Adult Day (MAD): provides meals, social activities, and companionship but can also offer therapies such as physical and occupational therapies and a nurse to help with medication management. 2. 1 INTRODUCTION Term Care (MLTC)/Medicaid Advantage Plus (MAP) services to over 440,000 members and are one of the largest health plans in New York City. • ! y • ! y • !, e • t tus • gins - " Information for All Providers – Managed Care Information . Oct 6, 2020 · Provider must comply with all contractual, administrative, medical management, quality management, and reimbursement policies as outlined in the CPHL provider contract, provider manual and updates. ADDITIONAL SERVICES: PHARMACY SERVICES - Medicaid Prior Authorization Requests submitted to Integra for all products except MLTC: Fax: 212. Perform key functions and get the information you need, all in one place. You have joined a network of physicians and other providers who partner with us to advance our mission of Anthem, Inc. We’re dedicated to improving the quality of life PROVIDER QUICK-REFERENCE GUIDE WE’RE METROPLUS. Search Formulary VNS Health MLTC is a Medicaid plan designed for New Yorkers who want to remain in their own homes and communities but need help with daily View Ivette Gonzalez's business profile as Manager, Provider Relations at Integra MLTC. Medicaid MLTC Plan Providers. (855) 661-0002 Partial LTC IX 01865329 Independent Care Systems (212) 584-2500 Partial LTC Call a Live VillageCareMAX Representative 1(800)469-6292 TTY/TTD 711 8AM - 8PM, 7 days a week Member Services Fax Number: 1(212) 337-5711 Get Started Today The Heath Plans provider portal gives you 24/7 access to authorizations, claims, eligibility, and more — without picking up the phone. 1 INTRODUCTION (MLTC)/Medicaid Advantage Plus (MAP) services to over 400,000 members and are one of the largest health plans in New York City. MANAGED CARE INFORMATION . within the timeframe specified in the provider agreement. org) No individuals have an ownership or controlling interest in VNSNY CHOICE (CHOICE) as described in 42 C. NPI record contains FOIA-disclosable NPPES health care provider information. : MEVS and Supplemental Documentation This information is not part of your provider manual, however, it may be useful information and is placed here for your convenience. Get Started Today The Heath Plans provider portal gives you 24/7 access to authorizations, claims, eligibility, and more — without picking up the phone. 2 Purpose of the Provider Manual; 2 MEDICARE ADVANTAGE OVERVIEW; 2. The 1841615630 NPI number is assigned to the healthcare provider INTEGRA MLTC INC. Provider Manual; RiverSpring Health Plans SNP Training; Compliance and Ethics Program Manual; NYDOH Provider Disclosure Certificate; Plan Code Plan ID # PCP Provider Name Telephone Number Plan Type . Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies, the provider manual and support for delivering benefits to our members. 5282 P V 20. (800) 597-3380 Mainstream IT 03475427 Integra MLTC, Inc (855) 661-0002 TTY (711) Partial LTC IX 01865329 Independence Care Systems (877) 427-2525 TTY (711) We are pleased to be able to offer this manual to CPHL’s providers. The combination of MLTC organizations and plan types results in 47 plans, however three of these plans, AgeWell New York, Integra MLTC, and Integra Synergy merged with other MLTC organizations in 2022 and are Integra Mltc Inc. Dec 17, 2024 · Claims Processing. R. NYE-PM-0007-16 This page is left intentionally blank. DISENROLLMENT FROM ANTHEM MLTC PLAN 52 . Anthem Provider sites required to comply with Senior Whole Health’s MLTC Provider Manual and its policies and procedures for matters such as claims, grievances, quality improvement, utilization management, credentialing, and health education. MLTC plans provide services and support to people that have a long term health problem or disability for more than 120 days. MLTC_2021_18184 The Provider Manual is a supplemental document to, and an extension of, your contract with SWH of NY. (800) 553-8247 Mainstream 92 00894519 Metroplus Health Plan, Inc. O. Discover more about Integra MLTC . § 455. Salaries can vary widely depending on the region, the department and many other important factors such as the employee’s level of education, certifications and additional skills. Login to the MyIntegra portal. Time outside the Service Area 50 . Where can I find Senior Whole Health Policy and Procedure information? E ffective 10/1/22, providers will be required to comply with Senior Whole Health’s MLTC Provider Manual and its policies and procedures for matters such as claims, grievances, Jan 3, 2025 · Provider Search - VNS Health MLTC (vnshealthplans. \(http Claims Processing. When you create a secure account, you get access to: Register for an Account The provider portal offers [] 2021 Nascentia Health Plus Provider Manual Page 1 of 59 Important Contact Information Our Website: www. •Print and electronic copies of the Anthem provider manual are available to all providers to ensure providers understand and adhere to established guidelines. New York State provider manuals, tip sheets, important forms, and applications (NYS health insurance). i May 2016 Provider Manual Table of Contents Term Care (MLTC) services to over 440,000 members and are one of the largest health plans in 1 day ago · Serving over 40,000 Medicaid members, Integra helps its members live safely and independently through its dedicated care management team, including a Registered Nurse, Social Worker, and Coordinator. You have joined a network of physicians and other providers who partner with us to advance our mission of Provider Manual - Anthem Blue Cross. Created Date: Integra Mltc Inc. IT 03475427 Integra MLTC, Inc (855) 661-0002 TTY (711) Partial LTC IX 01865329 Independence Care Information for All Providers – Managed Care Information NEW YORK STATE . Contact. The practitioner's main practice location is at 1981 Marcus Ave, New Hyde Park, NY 11042-2060; Integra Mltc Inc. Liberty Dental Provider Search. Member Services is also glad to discuss any concerns you may have about your care, and they can help you file complaints about your care or a service provider. Anthem has closed its acquisition of New York-based Integra Managed Care. Integra serves frail seniors and adults requiring long Explore additional business information. In cases where your contract and this document differ, the contract takes precedence. SWH of NY MLTC Provider Manual 2024 SWH of NY MLTC Provider Manual 2023 SWH of NY Medicare Provider Manual SWH of NY MLTC Provider Quick Reference Guide · Experience: Elevance Health (acquired Integra MLTC) Anthem Blue Cross and Blue Shield · Education: College of New Rochelle · Location: New York · 198 connections on LinkedIn. · Education: Columbia University, Teachers College · Location: Brooklyn · 414 5 days ago · MLTC Provider Manual; Provider manual; Essential Plan Provider Manual; Behavioral Health Quick Reference Benefit Grid . Medical policies and clinical UM guidelines. Read More. In accordance with the Medicaid Managed Long Term Care Partial Capitation Model This provider is an insurance company that provides a Medicaid Managed Long Term Care (MLTC) partially-capitated plan. This directory is current as of January 1, 2024. Last Update Date: 3/3/2014. It provides detailed information to answer many of the day-to-day operational questions about SWH of NY, our product, our members, and your relationship with us. Individual & Family; Medicare & Managed - Long Term Care Plans ; Quick Reference Guides; Quick Links. The National Provider Identifier (NPI) is #1457981979, which was assigned on January 23, 2020, and the registration record was last updated on January 23, 2020. Whether you’re a provider looking to work with more health plans, an insurer looking to provide smarter access to your membership, or a patient searching for local, quality care you can trust, Integra provides unparalleled access to a greater network. · Experience: Integra MLTC, Inc. 's primary practice location is listed as: Integra Mltc Inc. tjmga riwjo ryoshioy vye fvwzh xonuiq evlo rjrye jltg jaa