About Our Health Plans

We are the health plans from VNS Health. For 130 years, our organization has had a nonstop commitment to the communities we serve. We have deep experience caring for people at all stages of life, including those with multiple or complex health conditions.

Join a Health Plan

Whether you have just Medicare, have both Medicare and Medicaid, or need help with daily activities to live safely in the comfort of your home, we can help you choose the right plan for you.

Health Professionals

This is your gateway to the digital tools, policies, guidance, and materials you and your staff need to deliver high-quality service to your patients and clients in our health plans.

VNS Health Is More Than Health Plans

Our organization provides a full range of easy-to-access health care services that put you in control of your health and help you live your best life — at home and in your community.

All Provider Forms

Forms for Providers and Patients

Here you can find forms to join our network, update your demographic information, get prior authorizations for a patient’s medications, and more. You can find credentialing forms by clicking on this link.

Required for All Current Providers

Provider Disclosure Certification

You are required to fill out and return the provider disclosure certification form to VNS Health Health Plans. Please return it by December 31, 2021.

You can scan the completed document and email it as an attachment to: [email protected].

Or you can print it out and mail it to:
VNS Health
Health Plans – Provider Operations
220 East 42nd Street
New York, NY 10017

Download PDF: NYSDOH Provider Disclosure Certification

Last updated: July 9, 2020

Forms for New Providers

Join Our Provider Network

Thank you for your interest in joining our provider network. To get started, please submit your request for participation.

Forms for Current Providers

CDPAS Recertification – Physician Order Form

VNS Health Total and VNS Health MLTC members can have their home care service provided by a consumer directed personal care assistant through Consumer Directed Personal Assistance Services (CDPAS). The physician order form is required during the initial assessment and every 6 months during CDPAS recertification.

Download PDF: Form

Last updated: March 18, 2021

Delegated Roster Submission

Delegated entities are required to submit monthly/quarterly provider rosters.

Delegated Entities Provider Roster Template

Provider termination/add/update
Location termination/add
Demographic updates/removals

Visit our Credentialing page for more information.

Demographic Update Form

Participating primary care providers and specialists, here’s a quick and easy way to let us know about changes to your information!

EFT Request Form

To set up electronic funds transfer (EFT) payments, fill out this EFT Request Form by clicking on the link above.
Please note that to begin receiving EFT payments and remittances, you will also need to enroll with Availity to receive electronic remittance advice files. See Electronic Payment for Providers for details.

Provider Claims Dispute Form

Use this form to submit your claims disputes online. A representative will get back to you shortly.

SelectHealth HIV PCP Provider Annual Attestation Form

Transitional Concurrent Care Coverage Request Form

Transitional Concurrent Care (TCC) helps patients smoothly transition to hospice care. It includes curative treatments, for up to 60 days, after choosing hospice care with an in-network provider, and is coordinated between the TCC provider, hospice team, and the VNS Health care team, as applicable.

Prior Authorization Request Forms