Provider Training Materials
This Provider Orientation Training presentation contains an introductory overview of all VNSNY CHOICE health plans. The presentation features a brief overview of benefits, eligibility, and goals for each health plan. It also features documents that will help you with the on-boarding process. Please reach out to your assigned account manager with any further questions.
VNSNY CHOICE Quick Reference Guide: Total
VNSNY CHOICE Quick Reference Guide: MLTC
VNSNY CHOICE Quick Reference Guide: SelectHealth
The Quick Reference Guide is a convenient tool to refer to when you have questions about the following:
- Member Services
- Medical Management
- List of Participating Labs
SelectHealth Advantage Fact Sheet
Learn more about SelectHealth, including special initiatives and program offerings.
Provider EMR Data-Sharing – Measure Definitions
This guide lists the measures providers may be asked to document details for in the VNSNY CHOICE member medical record. Definitions, applicable lines of business, and sample procedure codes are also included.
Provider EMR Data-Sharing – Measure Dictionary
The EMR data-sharing measure dictionary details the approaches providers may use to achieve measure compliance and close gaps. By utilizing these guidelines, providers will be able to assist VNSNY CHOICE in achieving and reporting total quality of care for our members. Specifications, key elements, and timelines are also presented for reference.
VNSNY CHOICE LHCSA-FI Claim Submission Guide
Beacon Health Options Provider Reference Tool - Alcohol and Other Drug Dependence Treatment
This provider reference tool offers information about the initiation and engagement of treatment for alcohol and other drug dependence.
Beacon Health Options Provider Reference Tool - Follow-Up After Mental Illness Hospitalization
This provider reference tool offers information about the follow-up process after hospitalization for mental illness.
CONTOUR®NEXT ONE Meter and App System (Medicare only)
Beginning January 2018, VNSNY CHOICE will be partnering with Ascensia Diabetes Care to provide blood glucose meters and test strips to our Medicare members.
Read our letter to healthcare providers about this important service change.
Provider Portal User Guide
The Provider Portal User Guide is a step-by-step manual of how to set up our Provider Portal on a computer desktop. The portal will help you access several windows of information including:
- Member Eligibility
- Claim Status
- Set up for EFT
Provider Information Change Form
This form is extremely critical and helps ensure that all of your provider demographic information is current and complete. The form can be completed electronically and emailed directly to our Provider Operations Department or it can be faxed to our dedicated fax line.
Qualified Medicare Beneficiary Program (QMB)
The Qualified Medicare Beneficiary Program is a Medicare benefit which pays Medicare premiums and cost sharing for certain low-income Medicare beneficiaries. Review payment obligations and billing procedures with this guide.
Treatment of Gender-Dysphoric Persons Quick Reference Guide (SelectHealth only)
This guide provides a summary of recommended medication therapies along with their VNSNY CHOICE SelectHealth formulary coverage status.
Advanced Care Planning Form
Health Care organizations such as VNSNY CHOICE are required by New York State Department of Health regulations to provide information about Advanced Directives to all of our members.
The New York Health Care Proxy Law allows patients to appoint someone they trust, for example, a family member or close friend, to make health care decisions for them if they lose the ability to make decisions for themselves.
As sensitive as it can be, a proactive discussion of end-of-life issues with patients is extremely important to avoid confusion and potential discord regarding their preferences for care. VNSNY CHOICE has developed this downloadable one-page overview of Advance Care Planning that contains helpful suggestions and information about various forms of advance directives. We are also providing a basic Advance Care Planning Checklist to make it easier for you and your patients to assess needs. Additional forms include the following:
Pain Assessment, BMI/ Functional Status Chart
This chart is available in case you do not have a way to document the result of a member's Pain Assessment, BMI, or Functional Status in your EMR system. VNSNY CHOICE created this sheet to keep in the member’s chart to make it easier for you to document the member’s health vitals accurately.
AXIOM Solace Account Setup (MLTC Providers Only)
Once you're learned how to complete our billing spreadsheets, you'll need to become familiar with the setup of AXIOM Solace software. This program will allow you to upload your spreadsheets and have the claims reviewed for mistakes.
Access and Availability Standards
According to CMS, all health plans are required to maintain and monitor a network of appropriate providers, supported by written arrangements, that is sufficient to provide adequate access to covered services to meet the needs of the population served. This is a regulatory requirement that involves standards that must ensure that the hours of operation of the plan’s providers are convenient to, and do not discriminate against, enrollees. The plan must also ensure that, when medically necessary, services are available 24 hours a day, 7 days a week. This includes requiring primary care physicians to have appropriate backup for absences. The standards should consider the enrollee’s need and common waiting times for comparable services in the community. Please download this PDF for more information: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/mc86c04.pdf
Last updated 7/7/2020