Notices, News, and Updates

Provider News and Updates

In the rapidly transforming world of health care, we understand how important it is for you to stay up to date on changes that affect you, your practice, and your patients. Below are notices, recommendations, and updates that can help you keep track of changing standards and regulations. Check back regularly for new postings.

Newsletters and Bulletins

Read the latest issue— Summer 2023

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New Member ID Cards for 2023

Effective January 1, 2023, members of the health plans from VNS Health have new member ID cards, reflecting the new names of their plans.

Medicare Plans

We have three Medicare plans: VNS Health Total (HMO D-SNP), VNS Health EasyCare (HMO), and VNS Health EasyCare Plus (HMO D-SNP). Our three Medicare plan cards look like this. You can find the plan name on the “Plan” line.

VNS Health MLTC

You may not see ID cards from our Managed Long Term Care plan, VNS Health MLTC, as they aren’t required to be shown for services. But in case you do, they’ll look like the card on the right after January 1.

SelectHealth

We changed the name of our Medicaid special needs plan to SelectHealth from VNS Health and mailed out new ID cards last summer. SelectHealth member ID cards have a distinct look.

Guideline and Policy Updates

For All Health Plan Providers

For VNS Health Medicare Providers

As part of a continued effort to alert VNS Health Total (HMO D-SNP) PCPs of member health changes in real time, we are pleased to announce the 2021 rollout of a new report containing member inpatient admission or discharge information.

Member PCPs should expect to receive this alert via secure email or secure e-fax each time a member is admitted and discharged from an inpatient facility.

We request that providers review the information upon receipt and enter all pertinent information into the patient’s medical record. Within the alert providers will find the following:

Member demographic information
Admitting provider, diagnosis, and date
Discharge diagnosis, date, and length of stay (if applicable)

Other transitions of care best practices include:

Schedule follow-up visits within 14 days of discharge (in office, in home, or telehealth)
Conduct a medication reconciliation during a visit within 14 days of discharge, educating the patient or primary caregiver on any changes
- Tip: Code medication reconciliation in your electronic medical record to close quality gaps electronically:
  - TCM visit codes meet the Medication Reconciliation measure and close gaps
    - CPT code 99496 or 99495 for visits within 7 or 14 days, respectively
  - CPT II ® code 1111F meets the measure for visits between 1 and 30 days of discharge
- Review any potential requirements for tests and treatments, and follow up as needed
- Coordinate with the health plans care manager for assistance with referrals for in-network specialists and other services

These alerts are aimed at assisting providers in meeting the HEDIS® Transition of Care (TRC) measure, among others. Two TRC measure components include:

Documentation in the medical record that inpatient admission notification was received on the day of admission or the two following days (3 days total).
Documentation in the medical record that discharge information was received on the day of discharge or the two following days (3 days total).

Thank you for your dedication to our members and their health.

If you have any questions, or if you would like transitions of care workflow training for your office staff, please contact the Quality Management team at [email protected].

For SelectHealth from VNS Health Providers

As of April 1, 2023, patients enrolled in SelectHealth and other NY Managed Medicaid Plans began receiving their pharmacy benefits through NYRx, the Medicaid Pharmacy Program. To help avoid disruption, NYRx instituted a transition fill period until June 30, 2023, enabling patients to receive a one-time transition fill for a 30-day supply of a drug that would normally require prior authorization (PA).

Starting July 1, 2023, all claims will be subject to NYRx pharmacy program criteria listed on the NYRx preferred drug list (PDL). If you haven’t already, follow up to confirm transition to NYRx is complete for your patients.

Please review the Preferred Drug List (PDL). Preferred products generally do not require PA when prescribed according to FDA labelling. For any products with clinical criteria that require confirmed diagnosis of FDA-approved or compendia-supported indication, please ensure you enter the diagnosis on the patient’s medical claims.

Click here for more information.

Initiating PA for medications and diabetic testing supplies:
- Call Magellan at (877) 309-9493 – open 24/7
- Fax the PA form to (800) 268-2990
Initiating PA for Enteral Nutrition Supplements:
- Call NYRx at (866) 211-1736, option 1
Durable Medical Equipment (DME), Prosthetics, Orthotics, and Supplies (DMEPOS) procedures and supplies:
- Call OHIP DME at (800) 342-3005 for questions regarding DME PA criteria including frequency/quantity/durations limits and billing information
- Reminder: The items subject to the benefit transition are listed in Sections 4.1, 4.2, and 4.3 of the DMEPOS – Procedure Codes and Coverage Guidelines document and may be dispensed and billed directly to Medicaid through NYRx or by a FFS DMEPOS provider using the professional claim type. Most items do not require additional authorization prior to dispensing and billing.

The items not subject to the benefit transition are listed in Sections 4.4, 4.5, 4.6, and 4.7 of the DMEPOS – Procedure Codes and Coverage Guidelines document, and should continue to be billed to SelectHealth from VNS Health.