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
PROVIDER SERVICES CONTACT INFORMATION
Provider Services Contact Information
Provider Hotline 844-292-4211 (Monday through Friday, 9AM to 5PM)
- Press 1 for Authorizations.
- Press 2 for Claims.
- Press 3 for Member Eligibility.
- Press 4 for Provider Services or any other Provider Relations inquiry.
Provider Email Contacts
- Authorizations: ServiceAuths@centersplan.com
- Claims: Claims@centersplan.com
- Provider Services: ProviderServices@centersplan.com
- 844-CPHL-CARES / 844-274-5227 (7 Days a Week, 8AM to 8PM)
- Member Services: MemberServices@centersplan.com
- Part D Drugs are administered through our Pharmacy Benefit Manager, MedImpact. Access our website www.centersplan.com for our Formulary Listing.
Centers Plan for Medicaid Advantage Plus (HMO SNP) or MAP - Coming Soon
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
1564 Northeast Expressway
Mail stop: HQ-2361
Atlanta, GA 30329-2010
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).
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.
Medicare Prescriber Enrollment Requirement
CMS requires that any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. 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 requirement.
Prescription Drug Coverage Information
- 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
- Provider Manual – Last updated 02/2017
- Code of Conduct – Last updated 01/2017
- Fraud, Waste and Abuse Training and General Compliance Training – Last updated 01/2017
- SNP Model of Care (MOC) Training for Providers - Last updated 10/2017
- Medicare Part D Hospice Care Information
- NYS DOH Communicable Disease Reporting Requirements