Provider Resources
Centers Plan for Healthy Living’s mission is to work collaboratively with members, their families, healthcare decision makers, caregivers, and providers to break down barriers to accessing comprehensive healthcare. Our focus is on coordinating care for Medicare and/or Medicaid eligible populations and working with our members to live healthy, productive lives.
We value having a strong presence in the communities we serve, and providers in our network receive the same dedication, quality of services, and support to make our partnership a successful one. We are continually looking for new ways to improve our plans and welcome your input.
If you are interested in joining the CPHL Medicare Provider Network, please click here to submit your request.
You may also contact us via the following:
· Provider Hotline: 1-844-292-4211
· Email: ProviderServices@centersplan.com
Please remember to frequently review and update your information on the NPPES portal
PROVIDER SERVICES CONTACT INFORMATION
PROVIDER PORTAL
CLAIMS AND PAYMENT
Electronic Claim Submission and Payment
CPHL offers electronic claim submission through RelayHealth and electronic payment through PaySpan. Please click here for more information. You may also submit claims by mail to:
Centers Plan for Healthy Living
P.O. Box 21033
Eagan, MN 55121
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 CPHL website. 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).
Claim Reconsideration Request Form
CMS REQUIREMENTS
Provider Directory Requirement
CMS requires all Medicare Advantage Organizations (MAOs) 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, completion of the Demographic Change Form is required whenever you change or update your information.
HEDIS Guidelines for Health Care Providers
Prescription Drug Coverage Information
- Coverage Redetermination Request Form Last updated 10/12/2017
- Medicare Prescription Drug Exception Request and Coverage Determination Request Form Last updated 02/2019
- 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
- Waiver of Liability
Additional Resources
- Provider Manual – Last updated 12/2021
- Code of Conduct – Last updated 02/2020
- Fraud, Waste and Abuse Training and General Compliance Training – Last updated 01/2017
- SNP Model of Care (MOC) Training for Providers - Last updated 04/2021
- Medicare Part D Hospice Care Information
- Medicare Part D Hospice Care Form
- NYS DOH Communicable Disease Reporting Requirements
- Clinical Guidelines
- Model Waiver of Liability
- Notice of Medicare Non-Coverage
- Instructions for Medicare Non-Coverage
- MedImpact Direct Mail Order
- Podiatry CPT Codes
- Podiatry ICD-10 Codes
COVID-19 Letter to Providers
SNP Model of Care (MOC) Training