Helpful Links for VNSNY CHOICE Providers
Credentialing
ADA Accessibility Questionnaire
Download:
Attestation
Disclosure of Ownership Control Interest Statement
Download:
Document
Facility Credentialing Application
Download:
Application
Social Adult Day Site Visit Toolkit (MLTC Providers Only)
Download:
Toolkit
Claims
CMS-1500 Form
Download:
Sample Form
UB-04 Form
Download:
Sample Form
Required Data for Claims Forms
Download:
Document
Claims Submission for VNSNY CHOICE Providers
Download:
Claim Submission Guide
ICD-10 FAQs
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Document
Provider Remittance Guide
Download:
Fact Sheet
Billing Instruction for Nursing Home Providers
Download:
Document
Claims Layout for Provider Codes
Delegated Entities
Delegated Roster Submissions
Download:
Template
Quality
EMR Data Sharing Manual
Pharmacy
SelectHealth Opioid Safety Edits
Download:
Form
Medicare Part D Coverage Determination Form
Download:
Form
SelectHealth Link for Medication Request Form
Download:
Prior Authorization Form
Medication Adherence Tip Sheet
Download:
Tip Sheet
Other
Quick Reference Guide
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Reference Guide
SelectHealth Provider Reference Guide
Download:
Reference Guide
Provider Portal Manual
Download:
Portal User Guide