Provider Bulletins
- Community Laboratory Fee Schedule Effective January 1, 2023
- New York State Benefit Changes Effective 1/1/2023 for Medicaid Managed Care (MMC), Health and Recovery Plan (HARP), Essential Plan (EP), and Child Health Plus (CHP) Products
- Molina Availity Essentials Provider Portal
- Access and Availability Reminder
- Pharmacy Benefits Transitioning from Medicaid Managed Care Plan to NYRx, the Medicaid Pharmacy Program
- Provider Annual Attestations
- Help Your Patients Keep Their Health Insurance
- Required Cultural Competency Training for Participating Provider
- GoMo Health Assists in Outreach with Patients with Gaps in Care
- Required Cultural Competency Training for Participating Provider
Monroe-Plan-YourCare-IPA-Laboratory_Fee_Schedule-Effective-Jan-01-2023
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: December 1, 2022
SUBJECT: New York State Benefit Changes Effective 1/1/2023 for Medicaid Managed Care (MMC), Health and Recovery Plan (HARP), Essential Plan (EP), and Child Health Plus (CHP) Products
In accordance with New York State requirements, this notice is to provide updated member benefit information effective January 1, 2023, regarding the products referenced above as administered by Molina Healthcare of New York Inc.
Please note that some benefits may have limitations and if there are questions as to whether a service is covered or requires Prior Authorization, please reference the Prior Authorization tools located on the Molina website.
For additional information and a chart summary of the specific added benefits and services, please refer to the
attachment to this notice as well as visiting Molina’s website link below at:
https://www.molinahealthcare.com/providers/ny/medicaid/comm/bulletin.aspx
This notice and the updated grid will also be posted to the Monroe Plan website at (www.monroeplan.com) under the IPA and Provider Services tab.
As always, please do not hesitate to contact us directly at our general Provider Relations e-mail address providerrelations@monroeplan.com with any questions pertaining to this information.
Thank you for all you do for our members and our communities at large.
Click here to review benefit changes.
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: February 8, 2023
SUBJECT: Molina Availity Essentials Provider Portal
Beginning March 28, 2023, Availity Essentials will be the official secure provider portal for Molina Healthcare providers. Molina’s legacy portal will no longer be available for direct transactions. Please register on Availity to ensure that you have uninterrupted access to all your portal information, tools, and functions.
To register visit: https://www.availity.com/molinahealthcare
This notice and the updated grid will also be posted to the Monroe Plan website at (www.monroeplan.com) under the IPA and Provider Services tab.
As always, please do not hesitate to contact us directly at our general Provider Relations e-mail address providerrelations@monroeplan.com with any questions pertaining to this information.
Thank you for all you do for our members and our communities at large.
Provider Bulletin
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: March 1, 2023
SUBJECT: Access and Availability Standards
In accordance with New York State requirements, this notice is to serve as a reminder that New York State routinely completes surveillance activities to evaluate compliance with the following appointment availability standards, (Medicaid Model Contract 15.2, Appointment Availability Standards). By following the appointment availability standards established by the New York State Department of Health we can improve patient access to routine, urgent, preventive and specialty care. We also follow 24-hour access standards to measure after-hours access.
These standards apply to all lines of business, to learn more view our tip sheet: Access-and-Availability-Standards_MPwebsite_TIPS_2022.pdf (monroeplan.com)
This notice and the tip sheet will also be posted to the Monroe Plan website at (www.monroeplan.com) under the IPA and Provider Services tab.
As always, please do not hesitate to contact us directly at our general Provider Relations e-mail address providerrelations@monroeplan.com with any questions pertaining to this information.
Thank you for all you do for our members and our communities at large.
PROVIDER BULLETIN
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 03/23/2023
SUBJECT: Pharmacy Benefits Transitioning from Medicaid Managed Care Plan to NYRx, the Medicaid Pharmacy Program
Effective April 1, 2023, New York State Medicaid members enrolled in mainstream Medicaid Managed Care (MMC) Plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plans (SNPs) will have their pharmacy benefits transitioned from their Medicaid Managed Care Plan to NYRx, the Medicaid Pharmacy Program. Click the link below for information regarding the Pharmacy Benefit Transition in the October 2022 Special Edition Medicaid Update New York State Medicaid Update:October 2022 NYRx Pharmacy Benefit Transition.
Questions and Additional Information:
Guidance for Providers NOT Enrolled in Medicaid:
- Providers may check their enrollment status by reviewing the Medicaid Pended Provider Listing found here: Provider Verification
- Prescribers that are not enrolled in the Fee-For-Service program must enroll, to continue serving Medicaid Managed Care members. Instructions for checking enrollment status and enrollment tips can be found on the eMedNY Provider Enrollment
- Questions regarding the enrollment process, your enrollment status, or what you need to do to enroll, please contact providerenrollment@health.ny.gov or call the eMedNY Call Center at 1-800-343-9000
- Enrollment policy questions should be directed to the Medicaid Pharmacy Policy
Unit by telephone at (518) 486-3209 or by email at NYRx@health.ny.gov.
Guidance for Navigating the New NYRx Pharmacy Program:
- NY Medicaid Pharmacy Program Information for Prescribers: Prior Authorization Information
- NYS NYRx Quick Reference Guide: NYS NYRx FAQ
- Member Fact Sheet: What Members Need to Know Handout
As always, please do not hesitate to contact us directly at our general Provider Relations e-mail address providerrelations@monroeplan.com with any questions pertaining to this information.
Thank you for all you do for our members and our communities at large.
Provider Relations & Network Management
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 04/03/2023
SUBJECT: Provider Annual Attestations
ATTESTATION FORMS DUE MAY 1
Each year, Medicaid managed care providers are required to complete three brief attestation forms – DO, Employee, HIV forms. These forms are a NYS Medicaid Requirement. Below is a brief description of what each form will confirm. The forms are available through the Monroe Plan Provider Portal or our Monroe Plan website. If you have not already registered for the Monroe Plan Provider Portal, you can access the portal by clicking here: Monroe Plan Provider Portal or by visiting our website: Provider Resources & Forms – Monroe Plan for Medical Care. All forms should be sent to providerrelations@monroeplan.com.
If you have standard version of these forms already completed, you can submit those completed forms to providerrelations@monroeplan.com and that will satisfy this requirement.
Below is a list of attestation forms needed and a brief description of each form.
- Provider Employee Attestation Form: Use this form to certify that all employees and other provider personnel are not excluded or otherwise prohibited from participating in any state or federal healthcare program. This form needs to be attested and sent to Monroe Plan yearly.
- HIV Attestation Form: Use this form when attesting that you agree that you are an accredited HIV Provider. This form needs to be attested and sent to Monroe Plan yearly. If you are not an accredited HIV Provider, then this form can be left out of the annual attestation packet.
- Ownership Disclosure Form: Use this form to attest disclosure of ownership and financial interest of the group or facility. This form needs to be attested and sent to Monroe Plan yearly.
Thank you for all you do for our members and our communities at large.
Provider Relations & Network Management
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: May 8, 2023
SUBJECT: Provider Can Help Patients Stay Covered
Help Your Patients Keep Their Health Insurance
Medicaid, Essential Plan, Child Health Plus Benefits
Some of your patients could lose their NY State of Health Medicaid Managed Care, Child Health Plus or Essential Plan benefits if they do not complete their recertification paperwork on time. Unfortunately, your patients may not be familiar with the recertification process or how it applies to them.
We are asking for your help to boost awareness if you provide care and services to Molina members in the following plans: Molina Health Care of New York Medicaid Managed Care (MMC) Health Plan, Molina Healthcare PLUS Health Plan, Child Health Plus (CHPlus) Health Plan, or Essential Plan
Providers can play an important role in helping to keep their patients’ coverage without interruption. Please check your patients’ renewal (recert) date by going to the Molina Provider Portal (if you have not registered for the Molina provider portal, please visit this link: Molina Provider Portal and accessing the patient and eligibility details. You can also remind your patients that they will need to keep their health insurance to avoid any gaps in coverage. For more information visit: Renew My Coverage | Molina Healthcare of New York)
If members need more information they can call: Molina Healthcare at (844) 239-4911Y:711).
Thank you for all you do for our members and our communities at large.
Provider Relations & Network Management
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 6/7/2023
SUBJECT: Required Cultural Competency Training for Participating Provider
Required Cultural Competency Training for Participating Providers
The New York State Department of Health (DOH) has approved training offered by the United States Department of Health and Human Services (HHS), Office of Minority Health education program, Think Cultural Health, to fulfill the requirement for provider annual cultural competency training. The training is online, free, and offers several provider specific programs that can offer up to nine hours of CME credit hours. This program can be accessed at the following link: Education – Think Cultural Health (hhs.gov).
New York State previously approved cultural competency training for behavioral health providers (see: https://omh.ny.cultural_competency_curriculum.pdf ). Therefore, behavioral health providers, may utilize either the Think Cultural Health or the approved BH training to meet this requirement.
Once the cultural competency training has been completed, providers need to verify completion of the program by emailing the completed certificate to providerrelations@monroeplan.com be sure to complete this required Cultural Competency Training on or before October 1, 2023, and then annually thereafter.
Thank you for all you do for the community at large,
Provider Relations & Network Management
TO: Participating Monroe Plan IPA and YourCare IPA Network Primary Care Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: June 22, 2023
SUBJECT: GoMo Health Assists in Outreach with Patients with Gaps in Care
As the healthcare landscape continues to change, so too has the approach to patient care. Beginning April 2023 Monroe Plan for Medical Care rolled out a personalized text messaging campaign on behalf of our providers using GoMo Health to patients with select Gaps in Care.
This targeted approach to patient engagement, using an easy-to-use platform, has proven successful in the past. Through text, your patients are encouraged to connect with you to make appointments, escalate barriers to our care navigators for assistance, and participate in the creation of a plan of care that increases their health management skills.
Breast Cancer Screening Behavioral Health Follow Up
Cervical Cancer Screening Well Child Visits
Colorectal Cancer Screening Diabetes Testing
You may receive communication from Monroe Plan staff regarding appointments for patients OR you may receive calls from patients stating they’ve received a text message and need to schedule an appointment.
We welcome your feedback! Please reach out to Quality@monroeplan.com with any questions or comments.
Finally, if you desire to not have your Moline Healthcare assigned patients receive these texts, please complete the attached Opt-Out Form and e-mail or fax to the contact information listed.
Thank you for all you do for the community at large,
Provider Relations & Network Management
Participating Monroe Plan IPA and YourCare IPA Network Primary Care Providers
OPT-OUT OF IPA GAPS-in-CARE TEXTING PROGRAM to ASSIGNED PATIENTS
Practice Name:
Practice Tax ID #:
Authorized Signature:
Name and Title:
Date:
E-Mail to: pfmemails@monroeplan.com
or
Fax Number: 716-748-6987
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 9/15/2023
SUBJECT: Required Cultural Competency Training for Participating Provider
Required Cultural Competency Training for Participating Providers
The New York State Department of Health (DOH) has approved training offered by the United States Department of Health and Human Services (HHS), Office of Minority Health education program, Think Cultural Health, to fulfill the requirement for provider annual cultural competency training. The training is online, free, and offers several provider specific programs that can offer up to nine hours of CME credit hours. This program can be accessed at the following link: Education – Think Cultural Health (hhs.gov).
New York State previously approved cultural competency training for behavioral health providers (see: https://omh.ny.cultural_competency_curriculum.pdf ). Therefore, behavioral health providers, may utilize either the Think Cultural Health or the approved BH training to meet this requirement.
Once the cultural competency training has been completed, providers need to verify completion of the program by emailing the completed certificate to providerrelations@monroeplan.com be sure to complete this required Cultural Competency Training on or before October 1, 2023, and then annually thereafter.
Thank you for all you do for the community at large,
Provider Relations & Network Management
Network Compliance
Mainstream Medicaid Managed Care Providers are required to ensure the cultural competence of practice staff and to certify annual completion of New York State approved cultural competence training curriculum. The approved training, titled Think Cultural Health, offers several provider specific programs online, at no cost: https://thinkculturalhealth.hhs.gov/education. Providers and appropriate staff should complete this training in the next 12 months and annually thereafter. Once finished, please share your certificate of completion with us at providerrelations@monroeplan.com.
Be sure to review the bulletin and resource below to ensure cultural competency and compliance!
Thank you for your cooperation!