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Provider News Bulletin Fall 2022 | |
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Welcome Dr. Steven Merahn! | |
PHP welcomes our new Medical Director, Steven Merahn, MD! Visit the following link to read more. | |
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Stony Brook Medicine Joins PHP Provider Network | |
On September 1, 2022, Stony Brook Medicine joined the Partners Health Plan (PHP) provider network offering services to PHP members.
Kerry Delaney, PHP CEO stated, “We are very happy to welcome them back into our network. This will expand care options for PHP members. Stony Brook Medicine is an extensive health care system. It includes three acute care hospitals and many affiliated specialty groups and physicians with specialized services for individuals with Intellectual and Developmental Disabilities (IDD). This relationship will deepen the care choices that PHP members and their families have come to expect from us in providing state-of-the-art supports and services.” For more information on how to find Stony Brook Medicine providers and locations that are now part of the PHP provider network, please contact: providerrelations@phpcares.org.
About some of the facilities and services in the Stony Brook Medicine – PHP relationship 3 Acute Care Hospitals: - Stony Brook University Hospital, Stony Brook, NY
- Stony Brook Eastern Long Island Hospital, Greenport, NY
- Stony Brook Southampton Hospital, Southampton, NY
Here are some of the specialty services provided under the agreement: - Ambulatory Health Centers
- Cardiovascular Disease
- Dialysis
- Family Medicine
- GI and Hepatology
- Inpatient/Outpatient Psychiatry
- Mammography
- Oncology
- Orthopedics
- Podiatry
- Radiology
- Sleep Disorders
- Urology
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How to Receive Assistance from PHP's Network Development & Provider Relations Team | |
In order to contact the Provider Relations department to request assistance or information, please open a ticket using the Provider Ticket Submission Form. Once a ticket is submitted, a Provider Relations team member will reach out to you as soon as possible. | |
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Provider Relations Initiatives | |
Return to In-Person: The NDPR team is excited to get back into the field and meet with providers! If you’d like to meet with a representative from NDPR for a meeting or invite us to a community event, please reach out to your NDPR Account Manager or open a ticket with NDPR.
Provider Spotlight Series: The Provider Spotlight series is an opportunity for providers to showcase their services to PHP Clinical Team Leaders and Care Managers. We are seeking DD, healthcare or behavioral health providers, community organizations and more to present to our team. This series will allow PHP staff to learn the latest and greatest information that your organization has to offer and make referrals to your organization. If you are interested in presenting, please open a ticket and a member of our team will be in touch. 
Provider Satisfaction Survey: PHP’s Provider Satisfaction Survey helps us ensure we are best supporting our members, as well as our valued provider network. Your feedback helps us to offer quality support to our providers and implement strategic improvement plans based on your feedback. This survey will be sent out later this month. We’d appreciate your participation in our Provider Satisfaction Survey.
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We are Excited to Welcome Some of the New Providers Added to Our Network!
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- SUNY College of Optometry
- Easy Care PT
- Progressive Neurology, PC
- Omni Physical Therapy Services
- East Harlem Council for Community Improvement, Inc.
- BOOM! Health
- BQE Ophthalmology
- Yoon Behavioral Health
- St. Patrick’s Home for the Aged & Infirm
- City Rehab Physical Therapy PC
- The Vine Family Health PLLC
- Rehab Chains PT PC
- Total Care Podiatry, P.C.
- Way to Rehab PT PC
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Thank You to the Providers Who Recently Presented at Our Provider Spotlight Series! | |
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By Premila Kumar, Chief of Quality Initiatives
The Flu Vaccine – 2022
As we enter the 2022/23 flu season PHP wants to ensure we support all members and providers. The data from the CDC shows, that over the past several decades, the flu season typically starts in September and runs until about April and peaks between December and February. The seasonal flu is expected to impact approximately 11% of the US population and annually is accountable for between 30 to 50 thousand deaths (https://www.cdc.gov/flu/about/keyfacts.htm). The best way to support our members to reduce their risk is to ensure they have easy and early access to the flu vaccine. As part of our provider community, we want to work with you collaboratively to ensure our members have access to the flu vaccine and to remove any potential barriers. Our care management team can assist members, who are your patients, to connect with you and provide support with scheduling and transportation needs. PHP has already begun to provide flu vaccine information to members in a variety of means to emphasize the importance of getting their flu vaccine early. PHP covers all costs associated with our members getting the flu vaccine and also provides access to a 24/7 urgent/emergent telehealth program to support members who may become ill. This has allowed us to support members at home with your assistance and avoid the need for ER or Urgent Care visits related to the flu. Working together we can support our members, many of whom are high risk, to access and receive their flu vaccine early this season. CAHPS The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey was administered for Partners Health Plan (PHP) members from March through June in 2022. PHP is required to administer the survey developed by Centers for Medicare and Medicaid Services (CMS) every year. The surveys ask your patients or caregivers about their experiences with and ratings of their health care providers and plans. CAHPS survey captures information about health plan experiences, from the perspective of our members, for the following topic areas: Member Experience Based on surveys of member satisfaction with:
- Their health care coordination and doctors
- Ease of getting appointments and services
Medical Care
Based on how well the plan's network providers manage member health care, including:
- Providing regular screenings, vaccines, and other basic health services
- Drug plan and prescription management
- Monitoring conditions
Plan Administration Based on how well the plan is running, including:
- Customer service
- Access to needed information
- Network providers ordering appropriate tests and treatment
CMS uses the data from this survey to assign Star Ratings to health plans. Partners Health Plan uses the data from this survey to guide quality assurance and improvement efforts. The survey was fielded to 606 members, selected by CMS. Partners Health Plan’s response rate for 2022 was 25.9%; an increase of 2.6% compared to 2021. The annual flu vaccine measure increased 13.1% points when compared to 2021. There were increases in ratings from members for communication and care coordination provided by providers and getting needed prescription drugs. A decrease in ratings was noted for getting an appointment with a specialist and customer service. We value and appreciate the care you provide to our PHP members and look forward to continuing to partner with you to improve the overall CAHPS survey results. | |
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PHP is proud of our partnership with DentaQuest to increase access to oral health care for individuals with intellectual and/or developmental disabilities (IDD). Our dental provider network was curated to ensure we have adequate providers who specialize in offering dental services to adults with IDD by offering desensitization and sedation services. We will also begin covering the use of nitrous oxide as an alternative to sedation services, when appropriate. We have collaborated to implement dental case management, teledentistry, and mobile dentistry programs – all of which has resulted in a high volume of PHP members who have had a dental visit since the partnership began in 2022.
If you are a DD provider and would like to partner with us on a mobile dental clinic, please reach out to us! | |
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PHP has an in-house team of DME specialists to assist in ordering Durable Medical Equipment, Prosthetics, Orthotics, and Medical Supplies for PHP Care Complete FIDA-IDD Plan Participants.
If a patient you support needs any DME/POS items, please ensure that a complete script and letter of medical necessity (LOMN) is provided to PHP in a timely manner.
You can reach our DME team by phone at 646-455-1594 and by fax at 646-948-1027.
Prior Approval of Orthoses - PHP’s DME Department would like to remind our network providers that orthoses must be urgently prescribed and furnished may be dispense without prior approval in the following circumstances
- Item is being furnished by a physician or treating practitioner during an office visit where the provider determines that the brace is needed immediately due to medical necessity
- Item is being furnished by an occupational therapist or physical therapist who determines that the brace needs to be furnished as part of a therapy session(s).
- DME vendors should submit the authorization request for a post-service date to DME Department
- This applies to the following HCPCS codes: L0648, L0650, L1832, L1833, and L1851
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Claims Submission Made Easy PHP would like to remind our providers of the ease of establishing and submitting claims electronically. In addition, we would like to also remind everyone to regularly confirm with their billing service (Clearinghouse) that all electronic submissions have been successfully transmitted and received. If the claim is not successfully transmitted, there will be delays in PHP’s ability to adjudicate the claims on a timely basis. Please check all error logs and resubmit the claim accordingly – timely filing rules still apply for resubmissions. - Balance Billing is not Permitted
- Please be reminded that under New York State Law, a Provider participating in the Medicaid program, or a Medicaid Managed Care plan, is prohibited from requesting any monetary compensation from a Medicaid beneficiary, or their responsible relative. In addition, a Medicaid beneficiary, including a Medicaid managed care member, must not be referred to a collection agency for collection of unpaid medical bills or otherwise billed.
- To ensure prompt adjudication, please remember to send all claims to PHP using one of the following options:
- Mail
- Partners Health Plan P.O. Box 16309 Lubbock, TX 79490
- Electronic Submission
- Set up electronic claim submissions
- Change HealthCare EDI Claim Submission Change HealthCare Submitter ID: 14966 Change HealthCare
- Phone: 888-363-3361 (Note: a fee will be charged for setting up electronic claims mission online)
- You may also call HealthSmart Clearinghouse at 888-744-6638 to set up the electronic claim submission (free of charge).
- Web-based Claims Submission
- Providers can now easily create and upload a professional or institutional single claim as a pdf file via the provider portal (https://php.healthsmart.com).
- Web-based claims are considered paper claims and will follow all existing claim submission protocols.
- Please note that only valid claim forms (CMS 1500 or UB 04) may be updated using this method
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Credentialing/Re-Credentialing - Keep All Information Updated | |
Please send us any changes to your organization’s demographic information, as well as any updates to individual providers to ensure we always have the most up to date information loaded in our system!
PHP’s re-credentialing timeframe is every 3 years. We appreciate your cooperation with our re-credentialing process. | |
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Be on the lookout for future trainings!
Providers may send in requests for training by opening a “General Inquiry” ticket with NDPR.
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Do you have questions or concerns? Here's how to receive assistance from the Partners Health Plan’s Network Development and Provider Relations team! Partners Health Plan’s Network Development and Provider Relations team has updated our ticketing process! Going forward, in order to contact the Provider Relations department to request assistance or information, please open a ticket using the Provider Ticket Submission Form.
Once a ticket is submitted, a Provider Relations team member will reach out to you as soon as possible. If an email is sent to providerrelations@phpcares.org, an automatic email message will be sent prompting the submitter to use the Provider Ticket Submission Form to contact Provider Relations. | |
CLICK HERE to view all previous PHP Provider Newsletters. | |
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