Centers Plan for Healthy Living Providers

Thank You for being a participating provider in the Centers Plan for Healthy Living network.  Our goal is to provide our members/participants and their families with access to the plans, services and people they need to live healthier more productive lives.

Our team of health care professionals, are here to help simplify the process and provide the caring support  your patients need as they plan for and enjoy years of healthy living. Together we can ensure that all our members and their families get the most out their CPHL experience.

As a provider in our network you can expect the same dedication, quality of services and support to help make your experience a successful one. We are continually looking for new ways to improve our plans and partnerships with our network of providers and always welcome your input.

If you have any questions, contact our Provider Services Department at 1-844-292-4211 9AM to 5PM

How to become a CPHL provider:
Please contact our Provider Services Department,  if you are interested in becoming a Centers Plan Provider:
By phone at  1-844-292-4211,  Monday through Friday, 9AM to 5PM
By email at providerservices@centersplan.com.

New Payment Option

PaySpan® Health

FIDA Update:
On December 9, 2015 New York State Department of Health and CMS released guidance around FIDA program reforms to enhance the ease and value of the program to FIDA Participants, Plans and Providers. Highlights include:

  • Provider participation in an Inter Disciplinary Team (IDT) is adjustable, depending on their availability.
  • Primary Care Providers may review and sign off on Person Centered Service Plan (PCSP) without attending IDT meetings.
  • Providers are encouraged to take IDT training, but it is not mandatory.

FIDA Reform Letter – Last Updated 01/20/2016

FIDA Reform Summary – Last Updated 01/20/2016

FIDA Brochure – Last Updated 02/22/2016

FIDA Training Information:
As a participating Centers Plan for FIDA Care Complete Provider, you have the option to take a comprehensive FIDA provider training course. Please Click Here to access FIDA specific training materials or download the FIDA specific training materials below:

FIDA Overview Training – Last Updated 01/21/2016
FIDA Disability Awareness Training – Last Updated 01/21/2016
FIDA BH Training – Last Updated 01/21/2016
FIDA Cultural Competency Training – Last Updated 01/21/2016
FIDA Recovery and Wellness Training – Last Updated 01/21/2016

2016 Medicare Provider Directory Requirement:
Beginning in 2016, CMS will require all Medicare Advantage Organizations and Medicare-Medicaid Plans to conduct quarterly communications with contracted providers to ensure that provider directory information is up to date and accurately reflected on the plan’s online directory.

To ensure the plan and members have the most accurate information about your practice, CPHL asks for your cooperation in complying with this requirement by completing the Demographic Change Request Form whenever you change or update your practices information and submitting it to CPHL Provider Services Department by:
Email: providerservices@centersplan.com
Fax:    718-581-5562
Mail:  Centers Plan for Healthy Living
Provider Services Department
75 Vanderbilt Avenue,
Staten Island, NY 10304

2016 Medicare Prescriber Enrollment Requirement:
Beginning June 1, 2016 CMS will require that all Medicare Advantage providers, who prescribe medications  to Part D patients, be enrolled in (or validly opt out) of Medicare to be able to fully bill or for the limited purpose of prescribing Part D drugs.  If you are a provider who currently prescribes medications to Medicare patients, please Click Here access to the CMS Part D Prescriber Enrollment website  for helpful information about the new requirement.

Prescriber Outreach Communication

Provider Identity Theft:
Did you know healthcare providers are often the target of medical identity theft? Provider identity theft can have a significant financial impact on providers, plan sponsors and the Medicare program and is also potentially harmful to a provider’s professional reputation. The Centers for Medicare & Medicaid Services’ (CMS) Center for Program Integrity (CPI) has resources to support outreach efforts to the providers in your Medicare plan network. You can use these resources to educate providers about medical identity theft and other types of fraud, waste and abuse.

The new Provider Identity Theft video, a three-part interview series with Dr. Shantanu Agrawal, the Director of CPI, explains provider identity theft and its impact. Dr. Agrawal offers advice on how to recognize, report and prevent the fraudulent use of a provider’s medical identification information and describes the roles providers, plan sponsors and CMS play to address this important issue.

Hospice:
Hospice Information
Hospice Form

Claim Dispute Resolution: 
CPHL and its contracted providers are responsible for the timely resolution of any disputes between both parties.

CPHL informs providers about the dispute resolution process through the Provider Manual, provider orientation and the Plan’s website. Providers may also obtain information about the provider dispute process by calling the CPHL Provider Relations department at 844-292-4211.

Claim Dispute Instructions
Claim Dispute Request Form

Eligibility verification:
To verify the eligibility of a CPHL member / participant, please call our Member Services at 1-844-274-5227,  Monday – Friday, 8AM to 8PM or by email at memberservices@centersplan.com.

New York Medicaid Choice (NYMC) – NYS Enrollment Broker:
Phone: 1-855-600-FIDA (TTY 1-888-329-1542), Mon. – Fri., 8:30 am to 8 pm; Sat., 10 am to 6 pm
Write: New York Medicaid Choice, P.O. Box 5081, New York, NY 10274
Website: www.nymedicaidchoice.com

FIDA Participant Ombudsman:
The State of New York has created a participant ombudsman program called the Independent Consumer Advocacy Network (ICAN) to provide Participants free, confidential assistance on any services offered by FIDA Care Complete. ICAN may be reached toll-free at 1-844-614-8800 or online at www.icannys.org

Submitting Claims 
Click Here for instructions  on how to electronically submit claims directly to Relay Health.  You may also submit claims by mail to:

Relay Health
1564 Northeast Expressway
Mail stop: HQ-2361
Atlanta, GA 30329-2010

Communicable DiseaseForm

2017 Centers Plan for Medicare Advantage Care Materials

2017 Centers Plan for FIDA Care Complete (MMP) Materials

2017 Centers Plan for Nursing Home Care Materials

2017 Centers Plan for Dual Coverage Care Materials

 

Additional Resources:
Code of Conduct – Last updated 1/11/2017

Fraud, Waste and Abuse Training and General Compliance Training – Last updated 08/29/2016

Provider Manual – Last updated 02/16/2017

ICD-10 UPDATE – Last updated 08/25/2015

Frequently Asked Questions for Providers

 

FIDA Prior Authorization Requirements – Last updated 04/28/2017

FIDA Step Therapy Restrictions – Last updated 04/28/2017

FIDA Future Formulary Changes – Last updated 04/28/2017

 

MAPD Prior Authorization Requirements – Last updated 04/28/2017

MAPD Step Formulary Changes – Last updated 04/28/2017

MAPD Future Formulary Changes – Last updated 04/28/2017

 

Additional Forms:

Coverage Determination Request Form Last updated 11/05/2014

Coverage Redetermination Request Form Last updated 11/05/2014

Medicare Prescription Drug Determination Request Form for Participants and Providers Last updated 11/05/2014

Request for Prescription Information or Change – Provider Communication Form Last updated 10/28/2016

 

Additional Medicare Appeals Forms are available on Medicare.gov, please visit: www.medicare.gov

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