Provider Toolkit

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Provider Toolkit

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Provider Training Materials

VNSNY CHOICE Provider Services offers many helpful and informative education and training materials for our providers, and updates them regularly. The following materials and others are available when you call CHOICE Provider Services at 1-866-783-0222 (TTY: 711), Monday – Friday, 8 am – 8 pm:
 
 
VNSNY CHOICE Orientation Training (All Health Plans)
This Provider Orientation Training presentation contains an introductory overview of all VNSNY CHOICE health plans. The presentation features a brief overview of benefits, eligibility, and goals for each health plan. It also features documents that will help you with the on-boarding process. Please reach out to your assigned account manager with any further questions.

Quick Reference Guide (For MA, MLTC, and FIDA Providers) 
Quick Reference Guide (For SelectHealth Providers)

The Quick Reference Guide is a convenient tool to refer to when you have questions about the following:

  • Claims
  • Member Services
  • Medical Management
  • Utilization
  • Compliance
  • Pharmacy
  • List of Participating Labs

SelectHealth Advantage Fact Sheet
Learn more about SelectHealth, including special initiatives and program offerings.

Provider Portal User Guide
The Provider Portal User Guide is a step-by-step manual of how to set up our Provider Portal on a computer desktop. The portal will help you access several windows of information including:

  • Member Eligibility
  • Claim Status
  • Set up for EFT

Provider Information Change Form 
This form is extremely critical and helps ensure that all of your provider demographic information is current and complete. The form can be completed electronically and emailed directly to our Provider Operations Department or it can be faxed to our dedicated fax line.

Advanced Care Planning Form
Health Care organizations such as VNSNY CHOICE are required by New York State Department of Health regulations to provide information about Advanced Directives to all of our members.

The New York Health Care Proxy Law allows patients to appoint someone they trust, for example, a family member or close friend, to make health care decisions for them if they lose the ability to make decisions for themselves.

As sensitive as it can be, a proactive discussion of end-of-life issues with patients is extremely important to avoid confusion and potential discord regarding their preferences for care. VNSNY CHOICE has developed this downloadable one-page overview of Advance Care Planning that contains helpful suggestions and information about various forms of advance directives. We are also providing a basic Advance Care Planning Checklist to make it easier for you and your patients to assess needs. Additional forms include the following:

Appointing Your Health Care Proxy 
(EnglishSpanishChineseKoreanRussianHaitian-CreoleItalian)

New York Advance Directive Planning Guide

HEDIS Coding Reference Guide
Providers play a major part in helping VNSNY CHOICE achieve and report total quality of care for our members, beginning with services you provide and extending to the way you code them. You may use this guide to ensure that your efforts are on record. In doing so, you also help VNSNY CHOICE meet and exceed quality experience.

HEDIS Medicare Measures Quick Reference Guide
The HEDIS Measures Quick Reference Guide provides a summary of frequently recommended services along with suggested procedure codes for use in documenting and/or billing for these services.

Pain Assessment, BMI/ Functional Status Chart
This chart is available in case you do not have a way to document the result of a member's Pain Assessment, BMI, or Functional Status in your EMR system. VNSNY CHOICE created this sheet to keep in the member’s chart to make it easier for you to document the member’s health vitals accurately. 

AXIOM Solace Account Setup (MLTC Providers Only)
Once you're learned how to complete our billing spreadsheets, you'll need to become familiar with the setup of AXIOM Solace software. This program will allow you to upload your spreadsheets and have the claims reviewed for mistakes.

Access and Availability Standards
According to CMS, all health plans are required to maintain and monitor a network of appropriate providers, supported by written arrangements, that is sufficient to provide adequate access to covered services to meet the needs of the population served. This is a regulatory requirement that involves standards that must ensure that the hours of operation of the plan’s providers are convenient to, and do not discriminate against, enrollees. The plan must also ensure that, when medically necessary, services are available 24 hours a day, 7 days a week. This includes requiring primary care physicians to have appropriate backup for absences. The standards should consider the enrollee’s need and common waiting times for comparable services in the community. Please download this PDF for more information: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/mc86c04.pdf

 

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Have any questions?

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