We are happy to extend an invitation for you to contract with Partners Health Plan (“PHP”). We are the first managed care health plan approved by the Centers for Medicare and Medicaid Services (CMS), the State of New York Department of Health (SDOH) and the State of New York Office for People With Developmental Disabilities (OPWDD) to serve eligible adults with intellectual and other developmental disabilities (“I/DD”) in all five boroughs of New York City as well as Nassau, Rockland, Suffolk, and Westchester Counties.
PHP currently serves dually eligible people with I/DD that are at least 21 years of age and need medical, behavioral, dental, and long-term services and supports (“LTSS”) including Office of People with Developmental Disabilities (OPWDD) waiver services. Our Special Care Team, led by an RN, works with members and our providers on scheduling and follow up on medical issues and procedures. The reimbursement for this product is 100% of the Medicare rate. In addition, PHP will shortly begin a second product line that will provide services to the I/DD population with Medicaid only. The reimbursement for this program will be 100% of the Medicaid rate.
To join our provider network please complete the following steps:
Complete the Participating Physician Agreement – CLICK HERE TO COMPLETE AND SIGN
- Insert your address for notifications on page 9
- Complete and Execute the Agreement on page 11
- Complete exhibits A, B and C
- Sign Certification Regarding Lobbying on pages 23 and 32
Complete the Credentialing Materials – CLICK HERE TO COMPLETE AND SIGN
- Complete CAQH Access Form (Note: If you have a CAQH account and are able to provide your CAQH information, the Provider Application for Network Participation (pages 3-10) does NOT need to be completed and submitted)
- Complete the Provider Application for Network Participation (if no CAQH account and info) and attach/include all requested supporting materials.
- Complete The American with Disabilities Act (ADA) Attestation