6/1/2017. Payor Payor Type Product Transplants (some exclusions apply, contact your carrier for further information)

Transcription

1 6/1/2017 Mount Sinai Hospital/Mount Sinai Queens 1199 Union ADAP (opd only) S HIV program S HIV program Aetna U.S.Healthcare Insurance Co. HMO/POS/Indemnity MSBISLR non par with Indemnity C Community Plan Medicare Aetna whole health ACO ACO effective 1/1/17 Affinity Medicaid/Medicare HMO Medicaid Child Health Plus Family Health Plus Beacon Multi Product plan. ou MUST verify insurance product to Medicare HMO Exchange Product HIX QHP Alphacare FIDA American Case Mgmt (ACM) Specialty Medicaid Amerigroup Community Care Medicaid no contract Amerigroup ew ork (formerly Medicare HMO Medicare being transitioned to blue cross CarePlus) Child Health Plus no contract in negotiation c Family Health Plus AmidaCare SP HIV SP Medicare HMO ArchCare Medicaid/Medicare HMO Senior Life/PACE 2018 Jan Contracted Payers Page 1

2 BCE Emergis (up & up) Beech Street (Multiplan), Leased network Best Doctors, Leased network Centerlight Medicare HMO medicare hmo Cigna, includes Great West Insurance Co. HMO/POS ChoiceCare, Leased network Cigna Behavioral but through LifeSource they use Humana Connecticare, Inc.Connecticare of ew ork, Connecticare of Massachsetts HMO/POS Medicare Value Options Medicare SP Coventry ational etwork, Coventry Health Care Commercial, etwork Access, Worker's Compensation, Automobile Insurance Managed Care Crystal Run Individual/Family Medicaid Devon Health Service, Leased network Fresenius ESRD / Medicare Medicare HMO Direct Care America (health smart Insurance Co., EPO network) Doral etwork Medicaid Dental OL y y y Effective 1/1/17 Elderplan Medicare HMO Medicare HMO Emblem Insurance Co. CompreHealth HMO, value options CompreHealth, value options value options EmblemHealth /EPO value options Empire BC/BS Insurance Co. HMO POS/ 2018 Jan Contracted Payers Page 2 of 7

3 Indemnity Medicare ( Senior Plan) Child Health Plus Empire Plan S Employees Multi Product plan. ou MUST verify insurance product to Exchange Product Pathway & Pathway x Englewood Hospital self insured plan Fidelis Medicaid/Medicare HMO Medicaid Child Health Plus (IP and OP peds population [< Family Health Plus or = 21] only ) Medicare HMO Multi Product plan. ou MUST verify insurance product to Fidelis Exchange Product State of Health HBX First Health (formerly Affordable) Access through Coventry at MSBI, BSBIB, MSR and MSSL ForMost, Leased network Fresenius Medicare Advantage SP Glaxay Managed Care (MCI Ca Insurance Co. based) GHI HMO/POS etwork Acess Flex/Select Value Options Discontinued 4/1/2011 Medicare HMO EPO/ Global Medical Management Insurance Co. HealthFirst Medicaid A+ Child Health Plus essential Plan Commercial Product HFIC Family Health Plus HealthFirst (cont'd) Medicare HMO Life Improvement Plan, Increased Benefits Plan, Maximum Plan, Coordinated Benefits Plan, 65+ Multi Product plan. ou MUST verify insurance product to Exchange Product Leaf 2018 Jan Contracted Payers Page 3 of 7

4 HHH CHOICES HEALTH PLA Special eeds Plan Medicare Medicare/ HHH Choices Gold. HealthPlus 5/1/2012. see Medicaid Child Health Plus BMT only; solids through a transplant network Family Health Plus Medicare HMO H.I.P. Insurance Co. HMO/POS Medicare HMO Medicare SP Medicaid Value Options Family Health Plus Child Health Plus Exchange Product Select Care Humana Medicare HMO Medicare Advantage plan Independence Care System Medicaid (LIMITED SCOPE) FIDA Island Group Admin, Leased network Interlink Specialty Transplants Transplants LifeSource (CIGA) Specialty Transplants Transplants, but only for kidney, liver, small bowel and multivisceral. LifeTrac Specialty Transplants Transplants all transplant types Magellan Specialty Terminated eff 5/5/2012 MagnaCare (ex Global Excel, local 272 and 348) Managed Health etwork (MH) Specialty Mastercare Insurance Co. MedCare International MetraComp (COVETR) Insurance Co. HMO Terminated eff 5/19/2012 Multi Product plan. ou MUST verify insurance product to PATIET MUST VERIF WITH FACILIT IF COVERED UDER A LOCAL WELFARE FUD MetroPlus Medicaid 2018 Jan Contracted Payers Page 4 of 7

5 Medicare MSH SPECIALT SERVICES OL (O PCP'S EROLLIG) Child Health Plus Multi Product plan. ou MUST verify insurance product to Family Health Plus MSBISLR ALL SERVICES HIV SP (Partnership in Care) MetroPlus Gold Citycaid Exchange Plan Market Plus Multiplan (EX Global Excel), Leased network MVP ( OL) Insurance Co. ational Health Plan Inc., Leased network ational Preferred provider network Insurance Co. Oscar Health Plan Exchange Prodcut Oxford Health Plan Insurance Co. Freedom, Liberty HMO/POS Freedom, Liberty Medicare HMO Exchange product SHOP PHA Group (formerly DMA group) International ppo (will be using Optum) y PerfectHealth Insurance Co. HMO/POS *SEE HIP COTRACT Value Options Medicare POMCO Insurance Co. Private Healthcare System, Leased network (PHCS Mulitplan) Savility Proamerica Managed Care Insurance Co Jan Contracted Payers Page 5 of 7

6 Senior Health Partners Medicare Pace Program OT, ST dental only Select Health (VS Choice) SP HIV SP Select PRO Insurance Co. Senior Whole Health Special eeds Plan Medicare Medicare / Medicaid Advantage Medicare / Medicaid Advantage Plus Managed Long Term Care Plan Touchstone Medicare HMO Medicare HMO TravelCare United Health Care Insurance Co. HMO/POS Empire Plan S Employees ursing Home Plan (HMO SP) Medicare HMO (complete Focus) Medicare HMO United HealthCare Community Plan of ( formerly knows as Americhoice) United Behavioral use OptumHealth Medicare HMO Medicare HMO use OptumHealth Child Health Plus Family Health Plus Exchange Product Compass United Resource etwork Specialty Transplants Transplants except for Lung (OptumHealth) Vytra HMO/POS Discontinued Value Options Medicare HMO Medicare SP WellCare Insurance Co. Medicaid Child Health Plus y y essential Plan y y y Family Health Plus y y exchange y y y Medicare y VS Special eeds Plan Medicare Choice Preferred Choice Enhanced Choice Total Multi Product plan. ou MUST verify insurance product to (for the Complete Focus product line, the patient MUST activate their Passport Benefits via UHC) BISLW & EEI will disenroll in compass effective 2/1/ Jan Contracted Payers Page 6 of 7

7 Any box identified either as "" or an HMO slot require an "out of network" authorizarion PRIOR to services being rendered. Possible one time contract depending on Carrier request. Emergent transfers should have a sole source designation if bypassing the authorization requirements. In accordance with ew ork State regulations, all parties are required to review the contractual relationships to assure that the providers are contracted to the patients insurance carrier. Every patient should contact PLEASE OTE: FOR THE MEDICAID HMO'S. EXCEPT FOR SEIOR HEALTH PARTERS, ICS AD HIP MEDICAID, FOR ALL HOSPITAL CLIICS, IDIVIDUAL PHSICIAS EED TO BE BE CREDETIALED WITH EACH PLA I ORDER FOR THEIR CLAIMS TO BE PAID Request for access utilizing a non ew ork State Medicaid program MUST be pre arranged and include the credentialling of both the Hospital AD physician Plans that are higlighted are provided under the Ferderal ACA Statute. ou MUST check with the individual providers to This listing is provided as a convenience and is subject to change. Please contact the carrier directly if there are any questions on a specific product line Jan Contracted Payers Page 7 of 7