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 firstname.lastname@example.org.
New Payment Option
Additional Medicare Appeals Forms are available on Medicare.gov, please visit: www.medicare.gov
FIDA Provider Information
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:
Mail: Centers Plan for Healthy Living
Provider Services Department
75 Vanderbilt Avenue,
Staten Island, NY 10304
2016 Medicare Prescriber Enrollment Requirement
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
CLAIMS DISPUTE RESOLUTION & SUBMITTING CLAIMS
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
Click Here for instructions on how to electronically submit claims directly to Relay Health. You may also submit claims by mail to:
1564 Northeast Expressway
Mail stop: HQ-2361
Atlanta, GA 30329-2010
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.
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 email@example.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
- Coverage Determination Request Form Last updated 11/05/2014
- Coverage Redetermination Request Form Last updated 10/12/2017
- 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
- Waiver of Liability
- FIDA Non-Participating Provider Appeal Rights & Process Summary
- 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
- Communicable DiseaseForm
- SNP Model of Care (MOC) Training for Providers - Last updated 10/25/17