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Partners Health Plan prides itself on being a strong advocate for an inclusive world. We support health, love, happiness, change, justice, and unity. This includes every race, gender, sexual orientation, religion, and ability.
| | | | | | Partners Health Plan Celebrates its 4th Anniversary | |
On April 1st, 2020 Partners Health Plan celebrated its four-year anniversary. This program, a non-profit person-centered managed care organization, was created to specifically support people who have intellectual and developmental disabilities (IDD) including autism spectrum disorder, down syndrome, cerebral palsy, and traumatic brain injury.
By combining coverage and provider networks for Medicare, Medicaid and IDD services, members are provided with a cohesive, easy-to-navigate and individualized plan of care. Drawing from the support and experience of its long-established and trusted sponsor agencies: NYSARC and ADAPT Community Network (formerly United Cerebral Palsy of New York City), which are both leading providers of programs and services for people with developmental disabilities, Partners Health Plan is the premier health/IDD services plan in New York State.
In a discussion with Chief Executive Officer Kerry Delaney, she provided the following insight into the program. “We are dedicated to keeping each of our participants healthy, happy and as independent as possible while they pursue their dreams and valued outcomes in the diverse communities, they call home.” Ms. Delaney added, “Working in close collaboration with families and other members of the community, we will continue the proud NYARC/ADAPT tradition of supporting the unique needs and wishes of the individuals in their care, fully integrating their supports and services, advocating on their behalf, and assisting participants throughout their lives. Our goals are lofty, but so are the expectations of the people we are committed to supporting.”
In order to maintain an exceptional standard of care, Partners Health Plan’s two-person care coordination team supports members in obtaining appropriate person-centered services such as medical, vision and pharmaceutical needs as well as benefits such as durable medical equipment, telehealth, self-direction, home care, community habilitation, residential supports, transportation and much more. The PHP team coordinates and communicates with members, their families and their providers (doctors, residences, day programs, etc.) to ensure quality healthcare and services.
Covering so much more than health care, Partners Health Plan Partners is committed to providing members with the life they choose. “One of the primary concerns we hear from families is what will happen to their loved one after they are gone,” said Delaney. “Our goal is to put their minds at ease with the comfort of knowing that we will work tirelessly as trusted advocates for our members every day to help them live their best lives.” | | | | | |
HEDIS Measures and Performance Improvement | |
The Healthcare Effectiveness Data and Information Set (HEDIS) is one of health care’s most widely used performance improvement tools. HEDIS measures are reported using administrative (claims data) or hybrid methodology, which is a mix of claims data and chart review conducted by the health plan.
Our goal is for our Providers to submit claims using HEDIS-compliant codes, so you can get the credit you deserve for promoting excellence in clinical care. Submitting claims with HEDIS-Compliant Codes will also minimize the burden on Providers of the Plan conducting chart review during active HEDIS season. CLICK HERE for a HEDIS code and tip document for providers.
To help Providers minimize the burden of chart reviews/request, Partners Health Plan is happy to provide best practice training around HEDIS-compliant coding and documentation, tips on how practices can improve their scores and decrease their gaps in care. If you are interested, please contact providerrelations@phpcares.org.
| | | | | | | | It’s never too soon to start planning for the coming Flu Season. Feel free to download and share the PHP Flu Season Flyer and please talk with your patients to reinforce the value of getting a Flu Shot. Especially this year! | | | | | |
Welcome New Network Providers | | Partners Health Plan welcomes the following ancillary providers that recently joined the PHP Provider Network: - Chinese American Planning Council
- Daybreak Independent Services, Inc. (Daybreak)
- General Human Outreach (GHO)
- Modest Community Services
- Mill Neck Services
- NorWest
- Quality Services for the Autism Community (QSAC)
- Rising Tree Top
- Salvation Army
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Provider File Updates Begin | |
Partners Health Plan is looking to update organization information that is used for our claim system and provider directory among other reporting requirements. Earlier this summer our Account Field Managers began the process of distributing, via email, extracts of your organization's current listing. We are looking for our network to review and provide us with changes in addresses, office hours, specialties, language, medical record information and administrative contacts (as applicable). Once you have received this email notification please take the following steps: - Review the spreadsheet for accuracy and update the fields where appropriate.
- Highlight any updated information.
- Add Administrative contact information as appropriate (found in the last fields of the spreadsheet).
- Email the updated excel file to providerrelations@phpcares.org
Please contact Provider Relations at providerrelations@phpcares.org if you did not receive this email from your Account Field Manger, if you have any questions, or if there are new providers or services identified to be added to your organizations listing. | | | | | |
Provider Satisfaction Survey Being Reviewed | | Partners Health Plan would like to thank those providers who participated in the June 2020 Provider Satisfaction Survey! We are currently reviewing the results and developing a comprehensive action plan to ensure continued success and address challenges. Look for us to share feedback in our next issue.
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PHP Makes Claim Submissions Easy | | To ensure prompt adjudication remember to send all claims to PHP using one of the following options:
By Mail: Partners Health Plan P.O. Box 16309 Lubbock, TX 79490
By Electronic Submission: - Set up electronic claim submissions
- Change HealthCare EDI Claim Submission
- Change HealthCare Submitter ID: 14966
- Change HealthCare Phone: 888-363-3361
(A fee will be charged for setting up electronic claims mission online, you may also call HealthSmart Clearinghouse at 888-744-6638 to set up the electron claims submission free of charge).
| | | | Do you have questions or concerns? Please contact Partners Health Plan’s Network Development and Provider Relations team at providerrelations@phpcares.org | | | | | | | | | |
