Mount Sinai Hospital/Mount Sinai Queens Listing of Contracted Insurance Carriers

Transcription

1 Listing of Contracted Insurance Carriers Mount Sinai Hospital/Mount Sinai Queens 1199 Union PPO ADAP (opd only) NS HIV program NS HIV program N N Aetna U.S.Healthcare Insurance Co. HMO/POS/Indemnity MSBISLR non par with Indemnity PPO NC Community Plan Medicare Access Medicare Medicare HMO Medicare PACE Affinity Medicaid/Medicare HMO Medicaid Child Health Plus Family Health Plus Essential Plan Beacon Medicare HMO Multi Product plan. ou MUST verify insurance product to Exchange Product HIX QHP Alphacare FIDA American Case Mgmt (ACM) Specialty Behavioral Health Medicaid Amerigroup Community Care Medicaid HMO Medicaid N no contract Amerigroup New ork (formerly Medicare HMO Medicare being transitioned to blue cross CarePlus) Child Health Plus AmidaCare Essential Plan P p N no contract requires out of network authorization Family Health Plus Medicaid HMO SNP HIV SNP Medicare HMO y y y ArchCare Medicaid/Medicare HMO Senior Life/PACE BCE Emergis (up & up) PPO PPO Beech Street (Multiplan) PPO, Leased network PPO Best Doctors PPO, Leased network PPO Centerlight Medicare HMO medicare hmo Cigna, includes Great West Insurance Co. HMO/POS PPO ChoiceCare PPO, Leased network PPO N Cigna Behavioral but through LifeSource N they use Humana Connecticare, Inc.Connecticare of New ork, Connecticare of Massachsetts HMO/POS PPO Medicare N Value Options Coventry National Provider Network, Coventry Health Care Medicare SNP Commercial, Network Access, Worker's C ti A t bil Devon Health Service PPO, Leased network PPO Dent Direct Care America (health smart Insurance Co. PPO, EPO network) Doral Provider Network Medicaid Dental ONL N Elderplan Medicare HMO Medicare HMO Emblem Insurance Co. CompreHealth HMO, N February 2016 Contracted Payers.xlsx Page 1

2 CompreHealth PPO, N Essential Plan y N value options y EmblemHealth PPO/EPO N Empire BC/BS Insurance Co. HMO POS/PPO Indemnity Medicare ( Senior Plan) Child Health Plus Empire Plan NS Employees y y y Multi Product plan. ou MUST verify insurance product to Exchange Product Pathway & Pathway x Englewood Hospital self insured plan PPO Fidelis Medicaid/Medicare HMO Medicaid Child Health Plus Family Health Plus (IP and OP peds population [< or = 21] only ) Essential Plan p p Medicare HMO Multi Product plan. ou MUST verify insurance product to Fidelis Exchange Product N State of Health HBX First Health (formerly Affordable) PPO Access through Coventry at MSBI, BSBIB, MSR and MSSL ForMost PPO, Leased network PPO Glaxay Managed Care (MCI Ca based) Insurance Co. PPO GHI N HMO/POS N Value Options Network Acess N value options Flex/Select Discontinued 4/1/2011 Medicare HMO EPO/PPO N Value Options Global Medical Management Insurance Co. PPO HealthFirst Medicaid HMO Medicaid A+ Child Health Plus essential Plan HealthFirst (cont'd) Family Health Plus 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 HHH CHOICES HEALTH PLAN Special Needs Plan Medicare Medicare/ HHH Choices Gold. HealthPlus 5/1/2012. see Amerigroup Medicaid HMO Medicaid Child Health Plus BMT only; solids through a transplant network Page 2 of 5

3 Family Health Plus Medicare HMO H.I.P. Insurance Co. HMO/POS PPO Medicare HMO Medicare SNP Medicaid N Value Options Family Health Plus Child Health Plus Exchange Product Select Care Multi Product plan. ou MUST verify insurance product to Humana Medicare HMO Medicare Advantage plan Independence Care System Medicaid HMO Medicaid (LIMITED SCOPE) FIDA Island Group Admin PPO, Leased network PPO Interlink Specialty Transplants Transplants LifeSource (CIGNA) Specialty Transplants Transplants, but only for kidney, liver, small bowel and multivisceral. LifeTrac Specialty Transplants Transplants all transplant types Magellan Specialty Behavioral Health Behavioral Health Terminated eff 5/5/2012 MagnaCare (ex local 272 and 348) PPO PPO Managed Health Network (MHN) Specialty Behavioral Health HMO Behavioral Health N PPO Behavioral Health N Mastercare Insurance Co. PPO MedCare International PPO PPO Terminated eff 5/19/2012 MetraComp (COVENTR) Insurance Co. PPO MetroPlus Medicaid HMO Medicaid medicare MSH N SPECIALT SERVICES ONL (NO PCP'S ENROLLING) MSBISLR ALL SERVICES Child Health Plus Essential Plan p p p Family Health Plus HIV SNP (Partnership in Care) Multi Product plan. ou MUST verify insurance product to MetroPlus Gold Citycaid Exchange Plan Market Plus Multiplan PPO, Leased network PPO MVP (PPO ONL) Insurance Co. PPO N N National Health Plan Inc. PPO, Leased network PPO National Preferred provider network Insurance Co. PPO Oscar effective Plan will use Magnacare's provider network Exchange Prodcut Oxford Health Plan Insurance Co. Freedom, Liberty HMO/POS Freedom, Liberty PPO N N Page 3 of 5

4 Medicare HMO N Exchange product SHOP N PHA Group (formerly DMA group) International PPO ppo y PerfectHealth Insurance Co. HMO/POS *SEE HIP CONTRACT PPO N Value Options Medicare POMCO Insurance Co. PPO Private Healthcare System PPO, Leased network PPO (PHCS Mulitplan) Savility Proamerica Managed Care Insurance Co. PPO * Senior Health Partners Medicare Pace Program OT, ST dental only N N Select Health (VNS Choice) Medicaid HMO SNP HIV SNP Select PRO Insurance Co. PPO Senior Whole Health Special Needs Plan Medicare Medicare / Medicaid Advantage Medicare / Medicaid Advantage Plus Managed Long Term Care Plan Touchstone Medicare HMO Medicare HMO TravelCare PPO PPO United Health Care Insurance Co. HMO/POS PPO MSH Employee Empire Plan NS Employees N United Behavioral N use OptumHealth United HealthCare Community Plan of N ( formerly knows as Americhoice) essential Plan Medicare HMO Medicaid HMO Medicaid HMO N Medicare HMO Medicare HMO N N use OptumHealth p Multi Product plan. ou MUST verify insurance product to United Resource Network (OptumHealth) Specialty Transplants Child Health Plus N Family Health Plus N Exchange Product Compass Transplants except for Lung Vytra HMO/POS N N Discontinued PPO N Value Options Medicare HMO Medicare SNP WellCare Insurance Co. Medicaid Child Health Plus essential Plan Family Health Plus eschange Page 4 of 5

5 Medicare VNS Special Needs Plan Medicare Choice Preferred Choice Enhanced Choice Total Any box identified either as "N" or an HMO slot require an auth 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 PLEASE NOTE: FOR THE MEDICAID HMO'S. EXCEPT FOR SENIOR HEALTH PARTNERS, ICS AND HIP MEDICAID, FOR ALL HOSPITAL CLINICS, INDIVIDUAL PHSICIANS NEED TO BE BE CREDENTIALED WITH EACH PLAN IN ORDER FOR THEIR CLAIMS TO BE PAID (This applies to MSH N andmsh Queens). Request for access utilizing a non New ork State Medicaid program MUST be pre arranged and include the credentialling of both the Hospital AND 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. Page 5 of 5