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                    "post_date": "2020-08-03 19:31:31",
                    "post_date_gmt": "2020-08-03 19:31:31",
                    "post_content": "<!-- wp:acf\/hero {\n    \"id\": \"block_5f6b6da6418b3\",\n    \"name\": \"acf\\\/hero\",\n    \"data\": {\n        \"background_image_image\": \"\",\n        \"_background_image_image\": \"field_hero_background_image_image\",\n        \"background_image_caption\": \"\",\n        \"_background_image_caption\": \"field_hero_background_image_caption\",\n        \"background_image\": \"\",\n        \"_background_image\": \"field_hero_background_image\",\n        \"heading\": \"Grievances and Appeals\",\n        \"_heading\": \"field_hero_heading\",\n        \"subheading\": \"\",\n        \"_subheading\": \"field_hero_subheading\",\n        \"text\": \"\",\n        \"_text\": \"field_hero_text\",\n        \"button\": \"\",\n        \"_button\": \"field_hero_button\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:heading -->\n<h2 id=\"h-2021-vnsny-choice-total-hmo-d-snp-grievances-and-appeals\">2021 VNSNY CHOICE Total (HMO D-SNP) Grievances and Appeals<\/h2>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>If you have Medicare and get assistance from Medicaid, the information below applies to&nbsp;<strong>all&nbsp;<\/strong>of your Medicare and Medicaid benefits. You do not have to use one process for your Medicare benefits and a different process for your Medicaid benefits. This is sometimes called an \u201cintegrated process\u201d because it integrates Medicare and Medicaid processes.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-filing-an-organization-determination-also-known-as-a-coverage-decision-or-an-action\">FILING AN ORGANIZATION DETERMINATION (ALSO KNOWN AS A \u201cCOVERAGE DECISION\u201d OR AN \u201cACTION\u201d)<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>A Coverage Determination is when the plan, or delegated vendor has made an organization determination when it makes a decision about whether items or services are covered or how much you have to pay for covered items or services. Organization determinations are called \u201ccoverage decisions.\u201d &nbsp; You, your representative, or any provider that furnishes, or intends to furnish, services to you, may request an organization determination by filing a request with VNSNY CHOICE.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-filing-a-part-d-exception-which-is-also-a-coverage-decision-or-an-action\">FILING A PART D EXCEPTION (WHICH IS ALSO A \u201cCOVERAGE DECISION\u201d OR AN \u201cACTION\u201d)<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>If a drug is not covered in the way you would like it to be covered, you can ask VNSNY CHOICE to make an \"exception.\" &nbsp;An exception is a type of coverage decision. Similar to other types of coverage decisions, if we turn down your request for an exception, you can appeal our decision.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>When you ask for an exception, your doctor or other prescriber will need to explain the medical reasons why you need the exception approved. We will then consider your request. Here are three examples of exceptions that you or your doctor or other prescriber can ask us to make:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>Covering a Part D drug for you that is not on our plan's <em>List of Covered Drugs<\/em> <em>(Formulary)<\/em><\/li><li>Removing a restriction on the plan's coverage for a covered drug<\/li><li>Changing coverage of a drug to a lower cost-sharing tier<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:heading {\"level\":4} -->\n<h4 id=\"h-timeframes-for-coverage-decisions\">TIMEFRAMES FOR COVERAGE DECISIONS:<\/h4>\n<!-- \/wp:heading -->\n\n<!-- wp:list -->\n<ul><li>Standard Coverage Decision - Generally, on a request for a medical item or service, we will give you our answer within <strong>14 calendar days<\/strong> after receiving your request. If your request is for a Medicare Part B prescription drug, we will give you an answer <strong>within 72 hours <\/strong>of receiving your request.<\/li><li>For Medical Item or Service - Fast Coverage Decision is called an integrated expedited determination. A fast coverage decision means we will answer within <strong>72 hours<\/strong> of your request for a medical item or service. If your request is for a Medicare Part B prescription drug, we will answer within <strong>24 hours.<\/strong><\/li><li>For coverage decision about the drug(s) or payment - Fast Coverage Decision is called an expedited coverage determination: We will give you an answer within 24 hours after we receive your doctor's statement.<\/li><li>Claim Coverage Determinations - Notification of a decision will be made within 30 calendar days of receipt if they are submitted by you, or on your behalf or are claims that are not furnished under a written agreement between the plan and the provider. Claims from non-contracted providers must be paid or denied within 60 calendar days from the date of the request.<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-filing-an-appeal\">FILING AN APPEAL<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>If we say no to your coverage decision, you have the right to ask for an appeal. Asking for an appeal means asking us to reconsider \u2014 and possibly change \u2014 the decision we made. You may also ask for an appeal if you disagree with our decision to stop services that you are receiving. For example, you could file an appeal if:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>We refuse to cover or approve a service you think we should cover.<\/li><li>We refuse to pay for a service that was provided to you and you think we should pay for the service.<\/li><li>We reduce or cut back on a service you have been receiving.<\/li><li>You think we are stopping your coverage for a service too soon.<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:heading {\"level\":4} -->\n<h4 id=\"h-timeframes-for-appeals\">TIMEFRAMES FOR APPEALS:<\/h4>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>You must make your appeal request within 60 calendar days<strong> <\/strong>from the date on the written notice we sent to tell you our answer to your request for a coverage decision. If you miss this deadline and have a good reason for missing it, we may give you more time to make your appeal. Please include your reason in your appeal request.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Our timeframes to respond to your appeal are as follows:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>\u201cFast\u201d Appeal: When we are using the fast deadlines, we must give you our answer <strong>within 72 hours after we receive your appeal, <\/strong>this includes fast appeals for Medicare Part B drugs<strong>. <\/strong>If you ask for more time, or if we need to gather more information that may benefit you, we <strong>can take up to 14 more calendar days <\/strong>if your request is for a medical item or service. If we decide to take extra days to make the decision, we will tell you in writing. We can\u2019t take extra time to make a decision if your request is for a Medicare Part B prescription drug or a payment appeal.<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:list -->\n<ul><li>Standard Appeals: If we are using the standard deadlines, we must give you our answer on a request for a medical item or service <strong>within 30 calendar days<\/strong> after we receive your appeal if your appeal is about coverage for services you have not yet received. If your request is for a Medicare Part B prescription drug, we will give you our answer <strong>within 7 calendar days <\/strong>after we receive your appeal if your appeal is about coverage for a Part B prescription drug you have not yet received. We will give you our decision sooner if your health condition requires us to.<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:list -->\n<ul><li>If you ask for more time or if we need to gather more information that may benefit you, we can take up to 14 more calendar days if your request is for a medical item or service. If we decide we need to take extra days to make the decision, we will tell you in writing. We can\u2019t take extra time to make a decision if your request is for a Medicare Part B prescription drug or a payment appeal.<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:list -->\n<ul><li>If you believe we should not take extra days, you can file a \u201cfast complaint\u201d about our decision to take extra days. When you file a fast complaint, we will give you an answer to your complaint within 24 hours.<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:list -->\n<ul><li>If we do not give you an answer by the applicable deadlines above (or by the end of the extended time we took on your request for a medical item or service), we are required to send your request on to Level 2 of the appeals process. Then an independent outside organization will review it. For more information, please refer to your Member Handbook or call Member Services.<br><ul><li>Provider Claim Appeals: Please refer to the <a href=\"https:\/\/www.vnsnychoice.org\/for-health-professionals-overview\/claims-billing-and-payments\/\">Claims, Billing, and Payments section<\/a>.<\/li><\/ul><\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-filing-a-complaint-also-known-as-filing-a-grievance\">FILING A COMPLAINT&nbsp;(ALSO KNOWN AS \u201cFILING A GRIEVANCE\u201d)<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>A complaint is a process our members can use for certain types of problems <em>only.<\/em> This includes problems related to quality of care, waiting times, and the customer service you receive. If your problem is related to benefits, coverage decisions, or payment, please refer to the coverage decision and appeal sections above. Some examples of problems that would follow the complaint process are:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>You are treated rudely by anyone connected with your care such as your doctors, pharmacy, other healthcare providers, or plan representatives.<\/li><li>You are unable to reach someone by phone or get the information you need.<\/li><li>You are unhappy with the quality of care you received from a doctor or healthcare facility such as a clinic or hospital.<\/li><li>You have a problem with your doctor\u2019s office, whether it is the condition or cleanliness of the doctor's office, or you are kept too long in the waiting room.<\/li><li>We took too long to answer your coverage decision request, or appeal.<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:paragraph -->\n<p>For more information, see&nbsp;Common Questions about Filing an Appeal or Complaint, below.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"level\":4} -->\n<h4 id=\"h-timeframes-for-filing-complaints\">TIMEFRAMES FOR FILING COMPLAINTS:<\/h4>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>There is no time limit to filing a complaint, you can make the complaint at any time after you had the problem. We do recommend however that you file your complaint as soon as you are able to and provide as much information as you can to help us understand your problem and help resolve it sooner.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Our timeframes to respond to complaints are:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>\u201cFast\u201d Complaints: If you are making a complaint because we denied your request for a \u201cfast coverage decision\u201d or a \u201cfast appeal,\u201d or if we extended the timeframe of your coverage decision or appeal, we will automatically give you a \u201cfast\u201d complaint. If you have a \u201cfast\u201d complaint, it means we will give you an answer within 24 hours.<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:list -->\n<ul><li>Standard Complaints: Notification of a decision will be given within 30 calendar days of receiving the written or oral complaint. VNSNY CHOICE Total may extend the 30 calendar day timeframe by up to 14 calendar days if you or a provider on your behalf (written or oral) requests the extension or if VNSNY CHOICE justifies a need for additional information because it is in your best interest.&nbsp;<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-common-questions-about-filing-an-appeal-or-complaint\">COMMON QUESTIONS ABOUT FILING AN APPEAL OR COMPLAINT<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>Below are frequently asked questions about filing an appeal or complaint.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/faq {\n    \"id\": \"block_5f5ecd259de46\",\n    \"name\": \"acf\\\/faq\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_faq_heading\",\n        \"items_0_question\": \"What is the difference between a \u201cstandard\u201d and a \u201cfast\u201d or \u201cexpedited\u201d coverage decision for Medical Care? \",\n        \"_items_0_question\": \"field_faq_items_question\",\n        \"items_0_answer\": \"You can ask for a fast coverage decision only if you or any doctor believes that waiting for a standard coverage decision could cause serious harm to your health or hurt your ability to function. Fast decisions apply only to requests for medical care. You cannot get a fast decision on requests for payment for care you have already received.\",\n        \"_items_0_answer\": \"field_faq_items_answer\",\n        \"items_1_question\": \"What if my request for an expedited review is denied?\",\n        \"_items_1_question\": \"field_faq_items_question\",\n        \"items_1_answer\": \"If VNSNY CHOICE denies your request to file an expedited coverage decision, we will process the request under the standard timeframe and make a decision within 14 calendar days. The Plan will notify you orally and in writing within 3 calendar days that their expedited request will be handled under the standard timeframe, the member\u2019s right to file an expedited complaint; including the process and timeframe, the right to resubmit a request for an expedited determination and that if the member obtains any physician support indicating that applying the standard timeframe for making a determination could cause serious harm to you or hurt your ability to function, the request will be expedited.\",\n        \"_items_1_answer\": \"field_faq_items_answer\",\n        \"items_2_question\": \"What if I want to appeal a discharge from Facility Based Care?\",\n        \"_items_2_question\": \"field_faq_items_question\",\n        \"items_2_answer\": \"You have the right, by law, to ask for a review (an appeal) of a discharge date from the Hospital, Skilled Nursing Facility, Home Health Aide services, or Comprehensive Outpatient Rehabilitation Facility. You must contact the Quality Improvement Organization (QIO) for review. If you believe that you are being discharged too soon and appeal, you will receive a Detailed Notice of Discharge. The Detailed Notice of Discharge explains the specific reasons for the discharge. You can see a sample notice online at\u00a0<a href=\\\"https:\\\/\\\/www.cms.gov\\\/Medicare\\\/Medicare-General-Information\\\/BNI\\\/HospitalDischargeAppealNotices.html\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">www.cms.gov\\\/Medicare\\\/Medicare-General-Information\\\/BNI\\\/HospitalDischargeAppealNotices.html<\\\/a>.\\r\\n\\r\\nIf you do not ask the QIO for a \\\"fast appeal\\\" by the deadline (no later than\u00a0<strong>noon\u00a0<\\\/strong>on the day\u00a0after\u00a0the date your Medicare coverage ends), you may ask VNSNY CHOICE Total for a \\\"fast appeal\\\" of the discharge.<br data-rich-text-line-break=\\\"true\\\" \\\/><br data-rich-text-line-break=\\\"true\\\" \\\/>For more information on member appeal and complaint rights, please refer to the\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/for-members-vnsny-choice-total\\\/member-materials-2020\\\/\\\">2020 Member Handbook (Evidence of Coverage)<\\\/a>, <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/for-members-vnsny-choice-total\\\/member-materials\\\/\\\">2021 Member Handbook (Evidence of Coverage<\\\/a>,\u00a0or\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/contact-us-1\\\">contact us<\\\/a>.\",\n        \"_items_2_answer\": \"field_faq_items_answer\",\n        \"items_3_question\": \"How do I File a Complaint or Appeal?\",\n        \"_items_3_question\": \"field_faq_items_question\",\n        \"items_3_answer\": \"To file a complaint or request an appeal, please either:<br data-rich-text-line-break=\\\"true\\\" \\\/><br data-rich-text-line-break=\\\"true\\\" \\\/>Call Member Services at <a href=\\\"tel:1-866-783-1444\\\">1-866-783-1444<\\\/a> (TTY: <a href=\\\"tel:711\\\">711<\\\/a>). 8 am \u2013 8 pm, 7 days a week; or,<br data-rich-text-line-break=\\\"true\\\" \\\/><br data-rich-text-line-break=\\\"true\\\" \\\/>Members may also submit their appeals or complaints in writing and mail or fax to:<br data-rich-text-line-break=\\\"true\\\" \\\/>VNSNY CHOICE\u00a0Total<br data-rich-text-line-break=\\\"true\\\" \\\/>Medicare Grievance &amp; Appeals<br data-rich-text-line-break=\\\"true\\\" \\\/>P.O. Box 445<br data-rich-text-line-break=\\\"true\\\" \\\/>Elmsford, NY 10523<br data-rich-text-line-break=\\\"true\\\" \\\/>Fax: 1-866-791-2213<br data-rich-text-line-break=\\\"true\\\" \\\/><br data-rich-text-line-break=\\\"true\\\" \\\/>If you are not satisfied with the outcome of your appeal, details regarding your right to further appeal and your next steps will be included in your decision letter. Please refer to the\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/for-members-vnsny-choice-total\\\/member-materials-2020\\\/\\\">2020 Member Handbook (Evidence of Coverage)<\\\/a>,\u00a0 <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/for-members-vnsny-choice-total\\\/member-materials\\\/\\\">2021 Member Handbook (Evidence of Coverage)<\\\/a>, the\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/for-members-vnsny-choice-total\\\/member-materials-2020\\\/\\\">2020 Summary of Benefits<\\\/a>, <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/for-members-vnsny-choice-total\\\/member-materials\\\/\\\">2021 Summary of Benefits<\\\/a>),\u00a0or for more information, or please contact us. To appoint a representative to act on your behalf, please use the Appointment of Representative form (CMS-1696)\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/Appointment-of-Representative-_v.1_En.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">in English<\\\/a>\u00a0or\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/Appointment-of-Representative-_v.1_Sp.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">en espa\u00f1ol<\\\/a>.\",\n        \"_items_3_answer\": \"field_faq_items_answer\",\n        \"items_4_question\": \"How do I file an external complaint?\",\n        \"_items_4_question\": \"field_faq_items_question\",\n        \"items_4_answer\": \"You or your authorized representative may also file an external complaint with the Centers for Medicare and Medicaid Services (CMS) by:<br data-rich-text-line-break=\\\"true\\\" \\\/><br data-rich-text-line-break=\\\"true\\\" \\\/>Phone: <a href=\\\"tel:1-800-633-4227\\\">1-800-MEDICARE <\\\/a>(<a href=\\\"tel:1-800-633-4227\\\">1-800-633-4227<\\\/a>), 24 hours a day, 7 days a week. TTY\u00a0users should call <a href=\\\"tel:1-877-486-2048\\\">1-877-486-2048<\\\/a>.<br data-rich-text-line-break=\\\"true\\\" \\\/><br data-rich-text-line-break=\\\"true\\\" \\\/>Submit complaints:\u00a0<a href=\\\"file:\\\/\\\/\\\/C:\\\/Users\\\/35166\\\/AppData\\\/Local\\\/Microsoft\\\/Windows\\\/INetCache\\\/Content.Outlook\\\/DYNAHDXZ\\\/www.medicare.gov\\\/MedicareComplaintForm\\\/home.aspx\\\">www.medicare.gov\\\/MedicareComplaintForm\\\/home.aspx<\\\/a>.\",\n        \"_items_4_answer\": \"field_faq_items_answer\",\n        \"items_5_question\": \"How can I obtain the total number of complaints, appeals, and exceptions filed with the plan?\",\n        \"_items_5_question\": \"field_faq_items_question\",\n        \"items_5_answer\": \"To obtain the total number of complaints, appeals, and exceptions filed with the plan, please call us at <a href=\\\"tel:1-866-783-1444\\\">1-866-783-1444<\\\/a> (TTY; <a href=\\\"tel:711\\\">711<\\\/a>), 8 am \u2013 8 pm 7 days a week.<br data-rich-text-line-break=\\\"true\\\" \\\/><br data-rich-text-line-break=\\\"true\\\" \\\/>Or reach us by mail at:<br data-rich-text-line-break=\\\"true\\\" \\\/>VNSNY CHOICE<br data-rich-text-line-break=\\\"true\\\" \\\/>Medicare Appeals and Grievances<br data-rich-text-line-break=\\\"true\\\" \\\/>P.O. Box 445<br data-rich-text-line-break=\\\"true\\\" \\\/>Elmsford, NY 10523<br data-rich-text-line-break=\\\"true\\\" \\\/><br data-rich-text-line-break=\\\"true\\\" \\\/>For more information, please refer to the <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/for-members-vnsny-choice-total\\\/member-materials-2020\\\/\\\">2020\u00a0Member Handbook (Evidence of Coverage)<\\\/a> or the <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/for-members-vnsny-choice-total\\\/member-materials\\\/\\\">2021\u00a0Member Handbook (Evidence of Coverage)<\\\/a>.\",\n        \"_items_5_answer\": \"field_faq_items_answer\",\n        \"items_6_question\": \"Who can I contact if I have questions about the process, or if I have status questions?\",\n        \"_items_6_question\": \"field_faq_items_question\",\n        \"items_6_answer\": \"Call Member Services at <a href=\\\"tel:1-866-783-1444\\\">1-866-783-1444<\\\/a> (TTY: <a href=\\\"tel:711\\\">711<\\\/a>), 7 days a week, from 8 am \u2013 8 pm.\",\n        \"_items_6_answer\": \"field_faq_items_answer\",\n        \"items_7_question\": \"What are my protections in this plan?\",\n        \"_items_7_question\": \"field_faq_items_question\",\n        \"items_7_answer\": \"All Medicare Advantage Plans agree to stay in the program for a full year at a time. Each year, the plans decide whether to continue for another year. Even if a Medicare Advantage Plan leaves the program, you will not lose Medicare coverage. If your plan decides not to continue, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area.<br data-rich-text-line-break=\\\"true\\\" \\\/><br data-rich-text-line-break=\\\"true\\\" \\\/>If you have Medicare and get assistance from Medicaid, the information below applies to\u00a0<strong>all\u00a0<\\\/strong>of your Medicare and Medicaid benefits. You do not have to use one process for your Medicare benefits and a different process for your Medicaid benefits. This is sometimes called an \u201cintegrated process\u201d because it integrates Medicare and Medicaid processes.\",\n        \"_items_7_answer\": \"field_faq_items_answer\",\n        \"items\": 8,\n        \"_items\": \"field_faq_items\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->",
                    "post_title": "2021 VNSNY CHOICE Total (HMO D-SNP) Grievances and Appeals",
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                    "post_date": "2020-07-27 14:34:08",
                    "post_date_gmt": "2020-07-27 14:34:08",
                    "post_content": "<!-- wp:acf\/hero {\n    \"id\": \"block_5f1ee6c274e30\",\n    \"name\": \"acf\\\/hero\",\n    \"data\": {\n        \"background_image_image\": 668,\n        \"_background_image_image\": \"field_hero_background_image_image\",\n        \"background_image_caption\": \"\",\n        \"_background_image_caption\": \"field_hero_background_image_caption\",\n        \"background_image\": \"\",\n        \"_background_image\": \"field_hero_background_image\",\n        \"heading\": \"About Us\",\n        \"_heading\": \"field_hero_heading\",\n        \"subheading\": \"We are a mission-driven health care plan from VNSNY providing quality care for New Yorkers.\",\n        \"_subheading\": \"field_hero_subheading\",\n        \"text\": \"\",\n        \"_text\": \"field_hero_text\",\n        \"button\": {\n            \"title\": \"Learn about our health plans\",\n            \"url\": \"\\\/our-plans\",\n            \"target\": \"\"\n        },\n        \"_button\": \"field_hero_button\"\n    },\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:paragraph {\"align\":\"left\"} -->\n<p class=\"has-text-align-left\">VNSNY CHOICE is a health plan dedicated to the wellbeing, diversity, and vibrancy of New Yorkers.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"align\":\"left\",\"className\":\"is-style-default\"} -->\n<p class=\"has-text-align-left is-style-default\">We were among the first to create a Medicaid Managed Long Term Care (MLTC) plan in New York and know the ins and outs of New York\u2019s health care system. We have longstanding relationships with physician groups, hospital centers, private practices, and health systems.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"align\":\"left\",\"className\":\"is-style-default\"} -->\n<p class=\"has-text-align-left is-style-default\">As part of the VNSNY family, CHOICE is able to draw upon VNSNY\u2019s unmatched breadth and depth of clinical expertise. Our plans are designed to work closely with both plan members and their healthcare providers to offer customized solutions that keep members\u2019 health on track.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"align\":\"left\"} -->\n<p class=\"has-text-align-left\">This means: <\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>More comfort<\/li><li>More customizability<\/li><li>More coordination<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:paragraph {\"align\":\"left\"} -->\n<p class=\"has-text-align-left\">We understand that the ability of doctors, hospitals, and other care providers to tailor services to meet people\u2019s ethnic and cultural backgrounds has never been more important.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:buttons {\"align\":\"center\"} -->\n<div class=\"wp-block-buttons aligncenter\"><!-- wp:button {\"className\":\"is-style-outline\"} -->\n<div class=\"wp-block-button is-style-outline\"><a class=\"wp-block-button__link\" href=\"https:\/\/www.vnsnychoice.org\/our-plans\/\">Learn about our health plans<\/a><\/div>\n<!-- \/wp:button --><\/div>\n<!-- \/wp:buttons -->\n\n<!-- wp:acf\/divider {\n    \"id\": \"block_5f4d24b7213ee\",\n    \"name\": \"acf\\\/divider\",\n    \"align\": \"\",\n    \"mode\": \"auto\"\n} \/-->\n\n<!-- wp:acf\/stats {\n    \"id\": \"block_5f1eff47d60f2\",\n    \"name\": \"acf\\\/stats\",\n    \"data\": {\n        \"heading\": \"Just some of the reasons why CHOICE stands out\",\n        \"_heading\": \"field_stats_heading\",\n        \"description\": \"\",\n        \"_description\": \"field_stats_description\",\n        \"cards_0_icon\": 3316,\n        \"_cards_0_icon\": \"field_stats_cards_icon\",\n        \"cards_0_superheading\": \"Expertise \",\n        \"_cards_0_superheading\": \"field_stats_cards_superheading\",\n        \"cards_0_stat\": \"Medicare & Medicaid \",\n        \"_cards_0_stat\": \"field_stats_cards_stat\",\n        \"cards_0_description\": \"Helping your benefits work for you.\",\n        \"_cards_0_description\": \"field_stats_cards_description\",\n        \"cards_1_icon\": 741,\n        \"_cards_1_icon\": \"field_stats_cards_icon\",\n        \"cards_1_superheading\": \"Excellence\",\n        \"_cards_1_superheading\": \"field_stats_cards_superheading\",\n        \"cards_1_stat\": \"Quality Care\",\n        \"_cards_1_stat\": \"field_stats_cards_stat\",\n        \"cards_1_description\": \"A dedicated Care Team manages your needs.\",\n        \"_cards_1_description\": \"field_stats_cards_description\",\n        \"cards_2_icon\": 2991,\n        \"_cards_2_icon\": \"field_stats_cards_icon\",\n        \"cards_2_superheading\": \"Advocacy \",\n        \"_cards_2_superheading\": \"field_stats_cards_superheading\",\n        \"cards_2_stat\": \"On Your Side \",\n        \"_cards_2_stat\": \"field_stats_cards_stat\",\n        \"cards_2_description\": \"Champions for you and your loved ones.\",\n        \"_cards_2_description\": \"field_stats_cards_description\",\n        \"cards\": 3,\n        \"_cards\": \"field_stats_cards\",\n        \"button\": {\n            \"title\": \"Read more reasons to pick CHOICE\",\n            \"url\": \"https:\\\/\\\/www.vnsnychoice.org\\\/why-vnsny-choice\\\/\",\n            \"target\": \"\"\n        },\n        \"_button\": \"field_stats_button\"\n    },\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:acf\/media-text {\n    \"id\": \"block_5f5006bb09728\",\n    \"name\": \"acf\\\/media-text\",\n    \"data\": {\n        \"align_media_right\": \"0\",\n        \"_align_media_right\": \"field_media-text_align_media_right\",\n        \"is_youtube_video\": \"0\",\n        \"_is_youtube_video\": \"field_media-text_is_youtube_video\",\n        \"heading\": \"Expert Care Coordination for Complex Health Needs\",\n        \"_heading\": \"field_media-text_heading\",\n        \"body\": \"\u201cCare coordination is centered in the member\u2019s home, the setting that best promotes healing and well-being.\u201d  - Dr. Hany Abdelaal, President, VNSNY CHOICE <!-- wp:paragraph -->\\r\\n<p>Our plans enable the creation of a support team tailored to meet each member\u2019s particular physical and emotional needs. At VNSNY CHOICE, each member has a locally savvy Care Coordination Team, led by a nurse or social worker, who advocates for them and pulls all of their services together.<\\\/p>\\r\\n<!-- \\\/wp:paragraph -->\\r\\n\\r\\n<!-- wp:paragraph -->\\r\\n<p>With the security of this safety net, members are taking an increasingly active role in maintaining their health and living as independently and comfortably as possible in their own homes.<\\\/p>\\r\\n<!-- \\\/wp:paragraph -->\",\n        \"_body\": \"field_media-text_body\",\n        \"image\": 3359,\n        \"_image\": \"field_media-text_image\",\n        \"link\": \"\",\n        \"_link\": \"field_media-text_link\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:acf\/media-text {\n    \"id\": \"block_5f1f04e3d60f9\",\n    \"name\": \"acf\\\/media-text\",\n    \"data\": {\n        \"align_media_right\": \"1\",\n        \"_align_media_right\": \"field_media-text_align_media_right\",\n        \"is_youtube_video\": \"0\",\n        \"_is_youtube_video\": \"field_media-text_is_youtube_video\",\n        \"heading\": \"Deep Roots in the Communities We Serve\",\n        \"_heading\": \"field_media-text_heading\",\n        \"body\": \"As New Yorkers, we understand that living your best life in your own home and community is about more than just physical wellbeing. It\u2019s about all the pleasures and blessings of life. It\u2019s the feeling of independence that wellness makes possible. It\u2019s about feeling \u201cat home\u201d \u2014 comfortable and safe, surrounded by your favorite things, your best-loved family and friends, and your cherished experiences. It\u2019s where you belong.\",\n        \"_body\": \"field_media-text_body\",\n        \"image\": 924,\n        \"_image\": \"field_media-text_image\",\n        \"link\": \"\",\n        \"_link\": \"field_media-text_link\"\n    },\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:acf\/divider {\n    \"id\": \"block_5f2c4afabab97\",\n    \"name\": \"acf\\\/divider\",\n    \"mode\": \"auto\"\n} \/-->\n\n<!-- wp:paragraph {\"align\":\"left\"} -->\n<p class=\"has-text-align-left\">At VNSNY CHOICE, we are dedicated to our mission and to the members that we serve.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"align\":\"left\"} -->\n<p class=\"has-text-align-left\">We work with our members\u2019 physicians to extend their care into members\u2019 homes and communities.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"align\":\"left\"} -->\n<p class=\"has-text-align-left\">In all that we do, we do it for you: for our members\u2019 health and happiness, for our caregivers\u2019 peace of mind, for our provider and partners\u2019 delivery of the highest quality care.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/divider {\n    \"id\": \"block_5f2c4b6cbab99\",\n    \"name\": \"acf\\\/divider\",\n    \"mode\": \"auto\"\n} \/-->\n\n<!-- wp:acf\/content-feed {\n    \"id\": \"block_5f242fb831c92\",\n    \"name\": \"acf\\\/content-feed\",\n    \"data\": {\n        \"heading\": \"News and Updates\",\n        \"_heading\": \"field_content-feed_heading\",\n        \"subheading\": \"\",\n        \"_subheading\": \"field_content-feed_subheading\",\n        \"content_type\": \"news\",\n        \"_content_type\": \"field_content-feed_content_type\",\n        \"news_feed_options_feed_type\": \"manual\",\n        \"_news_feed_options_feed_type\": \"field_content-feed_news_feed_options_feed_type\",\n        \"news_feed_options_items_0_selected_item\": 3344,\n        \"_news_feed_options_items_0_selected_item\": \"field_content-feed_news_feed_options_items_selected_item\",\n        \"news_feed_options_items_1_selected_item\": 3640,\n        \"_news_feed_options_items_1_selected_item\": \"field_content-feed_news_feed_options_items_selected_item\",\n        \"news_feed_options_items_2_selected_item\": 3638,\n        \"_news_feed_options_items_2_selected_item\": \"field_content-feed_news_feed_options_items_selected_item\",\n        \"news_feed_options_items\": 3,\n        \"_news_feed_options_items\": \"field_content-feed_news_feed_options_items\",\n        \"news_feed_options\": \"\",\n        \"_news_feed_options\": \"field_content-feed_news_feed_options\",\n        \"button\": {\n            \"title\": \"See more recent news and updates\",\n            \"url\": \"https:\\\/\\\/www.vnsnychoice.org\\\/news\\\/\",\n            \"target\": \"\"\n        },\n        \"_button\": \"field_content-feed_button\"\n    },\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:paragraph -->\n<p><\/p>\n<!-- \/wp:paragraph -->",
                    "post_title": "About VNSNY CHOICE",
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                    "post_date": "2020-08-12 19:41:43",
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                    "post_content": "<!-- wp:table -->\n<figure class=\"wp-block-table\"><table><tbody><tr><td>Albany<\/td><td>Orange<\/td><\/tr><tr><td>the Bronx<\/td><td>Otsego<\/td><\/tr><tr><td>Columbia<\/td><td>Putnam<\/td><\/tr><tr><td>Delaware<\/td><td>Queens<\/td><\/tr><tr><td>Dutchess <\/td><td>Rensselaer<\/td><\/tr><tr><td>Erie<\/td><td>Richmond (Staten Island)<\/td><\/tr><tr><td>Fulton<\/td><td>Rockland<\/td><\/tr><tr><td>Greene<\/td><td>Saratoga<\/td><\/tr><tr><td>Herkimer <\/td><td>Schenectady<\/td><\/tr><tr><td>Kings (Brooklyn)<\/td><td>Schoharie<\/td><\/tr><tr><td>Madison<\/td><td>Suffolk<\/td><\/tr><tr><td>Monroe<\/td><td>Sullivan<\/td><\/tr><tr><td>Montgomery<\/td><td>Ulster<\/td><\/tr><tr><td>Nassau<\/td><td>Warren<\/td><\/tr><tr><td>New York (Manhattan)<\/td><td>Washington<\/td><\/tr><tr><td>Oneida<\/td><td>Westchester<\/td><\/tr><tr><td>Onondaga<\/td><\/tr><\/tbody><\/table><\/figure>\n<!-- \/wp:table -->",
                    "post_title": "CHOICE MLTC Service Area",
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                {
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                    "post_date": "2020-12-14 11:31:35",
                    "post_date_gmt": "2020-12-14 16:31:35",
                    "post_content": "<!-- wp:paragraph -->\n<p>VNSNY CHOICE Total (HMO D-SNP), a plan that combines Medicare Advantage and Medicaid Long-Term Care benefits, is pleased to announce its designation as a CMS Innovation Center Model participant for the Hospice Benefit Program beginning January 1, 2021.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Please note: In addition to your usual Notice of Election submission to CMS, all providers are also required to submit a Notice of Election to us within 5 days of hospice election. You can submit all Hospice Notice of Election material to <a href=\"mailto:CHOICEHospiceNOE@vnsny.org\">CHOICEHospiceNOE@vnsny.org<\/a>. <br><br>Or you can mail your Notice of Election to:<br>VNSNY CHOICE Membership Eligibility Unit <br>220 East 42<sup>nd<\/sup> Street, 3<sup>rd<\/sup> Floor<br>New York, NY 10017<br><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/faq {\n    \"id\": \"block_5fd7924818270\",\n    \"name\": \"acf\\\/faq\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_faq_heading\",\n        \"items_0_question\": \"I am a physician with a CHOICE Total patient in hospice care. Whom do I bill for my services?\",\n        \"_items_0_question\": \"field_faq_items_question\",\n        \"items_0_answer\": \"<p>If you are a physician who ordinarily provides primary or specialty care services to a patient who is now in hospice, you should bill CHOICE directly. You do not need to bill both CMS and CHOICE, unless you are specifically a hospice provider or facility.\u00a0<\\\/p>\",\n        \"_items_0_answer\": \"field_faq_items_answer\",\n        \"items_1_question\": \"What does it mean to participate in the CMS Innovation Center Model? \",\n        \"_items_1_question\": \"field_faq_items_question\",\n        \"items_1_answer\": \"Designation under the CMS Innovation Center Model means CHOICE Total, as a participating Medicare Advantage Organization (MAO) is responsible for coverage and payment of all services covered by Original Medicare, including hospice.\u00a0 These changes only apply to patients who elect to begin hospice care, receive that care from CHOICE Total and are enrolled in the plan in 2021.\",\n        \"_items_1_answer\": \"field_faq_items_answer\",\n        \"items_2_question\": \"How will participation better serve VNSNY hospice members? \",\n        \"_items_2_question\": \"field_faq_items_question\",\n        \"items_2_answer\": \"The hospice carve-in is intended to increase access to hospice services and facilitate better coordination between patients\u2019 hospice providers and their other clinicians. The Hospice Benefit Component of the Value Based Insurance Design (VBID) Model is an opportunity for CHOICE Total and hospice providers to collaborate and improve care coordination, transparency, and quality.\",\n        \"_items_2_answer\": \"field_faq_items_answer\",\n        \"items_3_question\": \"When will services begin?  \",\n        \"_items_3_question\": \"field_faq_items_question\",\n        \"items_3_answer\": \"Hospice services for qualifying members begin on January 1, 2021.\",\n        \"_items_3_answer\": \"field_faq_items_answer\",\n        \"items_4_question\": \"Where will these services be offered? \",\n        \"_items_4_question\": \"field_faq_items_question\",\n        \"items_4_answer\": \"These services will be offered in the Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk, and Westchester Counties.\",\n        \"_items_4_answer\": \"field_faq_items_answer\",\n        \"items_5_question\": \"How are notices and claims submitted for beneficiaries in participating plans? \",\n        \"_items_5_question\": \"field_faq_items_question\",\n        \"items_5_answer\": \"<p><strong>Claims must be submitted to both CHOICE Total and to the Centers for Medicare and Medicaid Services (CMS)<\\\/strong>.<strong>\u00a0<\\\/strong>We will be sending you more information about submitting hospice notices and claims.<\\\/p>\\r\\n<p>You may also view up-to-date information on the <a href=\\\"https:\\\/\\\/innovation.cms.gov\\\/innovation-models\\\/vbid-hospice-benefit-overview\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Model\u2019s website<\\\/a>.<\\\/p>\\r\\n\",\n        \"_items_5_answer\": \"field_faq_items_answer\",\n        \"items_6_question\": \"Who should I contact if I have questions?\",\n        \"_items_6_question\": \"field_faq_items_question\",\n        \"items_6_answer\": \"<ul>\\r\\n \\t<li><strong>Hospice Network Administrative Contact:<\\\/strong>\\r\\nTamara Romero <a href=\\\"mailto:%20Tamara.romero@vnsny.org%20\\\">\\r\\ntamara.romero@vnsny.org<\\\/a>\\r\\n<a href=\\\"tel:212-609-7546\\\">212-609-7546<\\\/a><\\\/li>\\r\\n \\t<li><strong>Clinical and Patient Support Contact:<\\\/strong>\\r\\nEsther Conteh\\r\\n<a href=\\\"mailto:Esther.Conteh@vnsny.org%20%20\\\">esther.conteh@vnsny.org<\\\/a>\\r\\n<a href=\\\"tel:212-609-1898\\\">212-609-1898<\\\/a><\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_6_answer\": \"field_faq_items_answer\",\n        \"items\": 7,\n        \"_items\": \"field_faq_items\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:acf\/resources {\n    \"id\": \"block_5fd7955624fba\",\n    \"name\": \"acf\\\/resources\",\n    \"data\": {\n        \"resource_groups_0_heading\": \"Training Materials\",\n        \"_resource_groups_0_heading\": \"field_resources_resource_groups_heading\",\n        \"resource_groups_0_resources_0_is_external_resource\": \"0\",\n        \"_resource_groups_0_resources_0_is_external_resource\": \"field_resources_resource_groups_resources_is_external_resource\",\n        \"resource_groups_0_resources_0_heading\": \"CMS Notice to Providers \",\n        \"_resource_groups_0_resources_0_heading\": \"field_resources_resource_groups_resources_heading\",\n        \"resource_groups_0_resources_0_description\": \"\",\n        \"_resource_groups_0_resources_0_description\": \"field_resources_resource_groups_resources_description\",\n        \"resource_groups_0_resources_0_files_0_file\": 6903,\n        \"_resource_groups_0_resources_0_files_0_file\": \"field_resources_resource_groups_resources_files_file\",\n        \"resource_groups_0_resources_0_files_0_label\": \"Notice from the Centers for Medicare & Medicaid Services\",\n        \"_resource_groups_0_resources_0_files_0_label\": \"field_resources_resource_groups_resources_files_label\",\n        \"resource_groups_0_resources_0_files\": 1,\n        \"_resource_groups_0_resources_0_files\": \"field_resources_resource_groups_resources_files\",\n        \"resource_groups_0_resources\": 1,\n        \"_resource_groups_0_resources\": \"field_resources_resource_groups_resources\",\n        \"resource_groups\": 1,\n        \"_resource_groups\": \"field_resources_resource_groups\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->",
                    "post_title": "CHOICE Total Will Cover Hospice Services for Qualifying Members in 2021",
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                    "post_date": "2020-09-17 17:56:59",
                    "post_date_gmt": "2020-09-17 17:56:59",
                    "post_content": "<!-- wp:paragraph {\"align\":\"left\"} -->\n<p class=\"has-text-align-left\">Please check back for updates.<\/p>\n<!-- \/wp:paragraph -->",
                    "post_title": "Coming Soon",
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                {
                    "ID": 378,
                    "post_author": "3",
                    "post_date": "2020-07-09 17:19:23",
                    "post_date_gmt": "2020-07-09 17:19:23",
                    "post_content": "<!-- wp:acf\/hero {\n    \"id\": \"block_5f4d3a30d1240\",\n    \"name\": \"acf\\\/hero\",\n    \"data\": {\n        \"background_image_image\": \"\",\n        \"_background_image_image\": \"field_hero_background_image_image\",\n        \"background_image_caption\": \"\",\n        \"_background_image_caption\": \"field_hero_background_image_caption\",\n        \"background_image\": \"\",\n        \"_background_image\": \"field_hero_background_image\",\n        \"heading\": \"Compliance Program\",\n        \"_heading\": \"field_hero_heading\",\n        \"subheading\": \"\",\n        \"_subheading\": \"field_hero_subheading\",\n        \"text\": \"\",\n        \"_text\": \"field_hero_text\",\n        \"button\": \"\",\n        \"_button\": \"field_hero_button\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<h3><strong>Commitment to Compliance<\/strong><\/h3>\n<p>Consistent with the long tradition of ethical and responsible conduct of the Visiting Nurse Service of New York (VNSNY), VNSNY CHOICE is committed to serving its members, providers and everyone with whom it does business pursuant to the highest ethical, business and legal standards.<\/p>\n<p>To that end, VNSNY CHOICE has implemented a comprehensive\u00a0<a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2020\/07\/VNSNY-Compliance-Program-Structure-and-Guidelines.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Compliance Program<\/a>\u00a0to ensure that legal and ethical conduct is an integral part of our organization\u2019s culture and operations.<\/p>\n<h3><strong>Code of Conduct<\/strong><\/h3>\n<p>The VNSNY\u00a0<a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2021\/04\/VNSNY-Compliance-Program-Code-of-Conduct.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Code of Conduct<\/a>\u00a0is a statement of ethical and compliance principles that guide the daily operations of VNSNY, its subsidiaries and affiliates, including VNSNY CHOICE. The Code of Conduct establishes key ethical principles that we require all directors, officers, employees, contractors, agents, First Tier, Downstream and Related Entities (\u201cFDRs\u201d) and others associated with VNSNY and its FDRs to follow, as well as standards to help ensure compliance with applicable laws and company policies.<\/p>\n<p>The Code of Conduct requires VNSNY CHOICE\u2019s employees, Board members, administrators, physicians, volunteers, and those with whom we do business to report any action(s) that may be unlawful, inappropriate, or in violation of the Code of Conduct, applicable policies and procedures, or applicable laws, rules, and regulations.\u00a0<strong>Be assured, there will be no intimidation of, or retaliation against, anyone who in good faith reports a compliance concern.<\/strong><\/p>\n<h3><strong>Compliance Policies and Procedures<\/strong><\/h3>\n<p>VNSNY CHOICE and VNSNY have adopted and implemented numerous compliance policies and procedures that further support our commitment to compliance, as embodied in the Compliance Program and Code of Conduct, and ensure that the Program is operating effectively and with integrity. These policies and procedures include, without limitation:<\/p>\n<p><a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2020\/07\/VNSNY-CHOICE_SH_Non-Discrimination-Notice_Eng.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Nondiscrimination\u00a0Notice<\/a><\/p>\n<p><a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2021\/04\/VNSNY-Non-Retaliation_Non-Intimidation_Whistlebower-Policy.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">VNSNY Policy on Non-Retaliation and Non-Intimidation<\/a><\/p>\n<p><a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2021\/04\/CHOICE-Fraud-Waste-Abuse-Dection-Manual.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">VNSNY CHOICE Health Plans\u00a0Fraud, Waste, and Abuse\u00a0Detection Manual<\/a><\/p>\n<p><a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2020\/11\/VNSNY-Fraud-Waste-Abuse.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The Detection and Prevention of Fraud, Waste and Abuse and Applicable Federal and State Laws (DRA Policy)<\/a><strong>\u00a0<\/strong><\/p>\n<p><a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2021\/04\/VNSNY-Corporate-Policy-Procedures_Sanction-Check.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Sanction Checks<\/a><\/p>\n<h3><strong>Policy How to Report a Compliance Concern<\/strong><\/h3>\n<p>Anonymous Hotlines and Online Reporting Tool<\/p>\n<p>VNSNY CHOICE Hotline: (888) 634-1558<\/p>\n<p>VNSNY Online Reporting Tool:\u00a0<a href=\"http:\/\/www.vnsny.ethicspoint.com\/\" target=\"_blank\" rel=\"noopener noreferrer\">www.vnsny.ethicspoint.com<\/a><\/p>\n<p>Through our Hotline and Online Reporting Tool, individuals can report a compliance concern, including fraud, waste and abuse, or seek guidance about compliance questions:<\/p>\n<ul>\n<li>24 hours, 7 days a week<\/li>\n<li>Anonymously, if you choose<\/li>\n<li>Without worry of retaliation or intimidation<\/li>\n<\/ul>\n<p>Any individual may make a report. All reports will be taken seriously and, if warranted, investigated by Compliance or the Special Investigations Unit.<\/p>\n<p>When making a report, please provide as much detail as possible, such as names, dates, and a description of the issue. Unless you prefer to remain anonymous, please include your name and telephone number so that we may contact you if we have any questions during our investigation.<\/p>\n<h3><strong>Fraud, Waste, and Abuse Detection and Prevention<\/strong><\/h3>\n<p>VNSNY CHOICE has established a comprehensive Fraud, Waste, and Abuse Prevention Program to prevent, detect, and correct fraud, waste, and abuse by employees, members, providers, agents, contractors and FDRs of VNSNY CHOICE. For more information, please see the\u00a0<a href=\"https:\/\/www.vnsnychoice.org\/prevention-and-detection-fraud-waste-and-abuse\/\">Fraud, Waste and Abuse Detection and Prevention<\/a>\u00a0page.<\/p>\n<h3><strong>Compliance Leadership<\/strong><\/h3>\n<p>Individuals can always contact VNSNY CHOICE Compliance directly with any compliance concerns or questions.<\/p>\n<p><strong>VNSNY Chief Compliance and Privacy Officer<\/strong><br \/>Annie Miyazaki-Grant <br \/>SVP, Chief Compliance &amp; Privacy Officer<br \/>(212) 609-7470<br \/><a href=\"mailto:Annie.Miyazaki-Grant@vnsny.org\">Annie.Miyazaki-Grant@vnsny.org<\/a><\/p>\n<p><strong>VNSNY CHOICE Compliance Officer<\/strong><br \/>Doug Goggin-Callahan<br \/>VP, CHOICE Compliance &amp; Regulatory Affairs<br \/>(201) 779-2584<br \/><a href=\"mailto:Doug.Goggin-Callahan@vnsny.org\">Doug.Goggin-Callahan@vnsny.org<\/a><\/p>\n<h3><strong>Other Ways to Contact Compliance<\/strong><\/h3>\n<p>Individuals can also send materials to the CHOICE Compliance Department by fax or mail:<\/p>\n<p>Attn: VNSNY CHOICE Compliance Department<br \/>220 East 42nd Street, 3rd Floor<br \/>New York, NY 10017<br \/>(646) 459-7730 (fax)<\/p>\n<p>VNSNY CHOICE Hotline: <a href=\"tel:(888) 634-1558\">(888) 634-1558<\/a><\/p>\n<p>VNSNY Online Reporting Tool:\u00a0<a href=\"http:\/\/www.vnsny.ethicspoint.com\/\" target=\"_blank\" rel=\"noopener noreferrer\">www.vnsny.ethicspoint.com<\/a><\/p>\n<p><strong>Helpful Links:<\/strong><\/p>\n<p><a href=\"https:\/\/www.cms.gov\/Medicare\/Compliance-and-Audits\/Part-C-and-Part-D-Compliance-and-Audits\/ComplianceProgramPolicyandGuidance.html\" target=\"_blank\" rel=\"noopener noreferrer\">CMS Compliance Program Policy and Guidance<\/a>\u00a0\u2013 Information on Centers for Medicare and Medicaid Services (CMS) Compliance Program requirements and links to compliance training.<\/p>\n<p><a href=\"https:\/\/omig.ny.gov\/compliance\/compliance-library\" target=\"_blank\" rel=\"noopener noreferrer\">NYS OMIG Compliance<\/a>\u00a0\u2013 New York State Office of the Medicaid Inspector (NYS OMIG) General Bureau of Compliance page, with links to the Compliance Library.<\/p>\n<p><a href=\"http:\/\/www.hhs.gov\/ocr\/privacy\/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">HHS Office of Civil Rights - HIPAA<\/a>\u00a0\u2013 U.S. Department of Health and Human Service Office of Civil Rights website offers information on health information privacy and security.<\/p>\n<p><a href=\"http:\/\/www.health.ny.gov\/\" target=\"_blank\" rel=\"noopener noreferrer\">New York State Department of Health<\/a>\u00a0\u2013 Information about New York State Department of Health, as well as Model Contracts for VNSNY CHOICE\u2019s Medicaid Managed Long Term Care (MLTC) and Medicaid Managed Care Special Needs Plan (SNP) can be accessed here.<\/p>",
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                    "post_date": "2020-12-03 17:49:49",
                    "post_date_gmt": "2020-12-03 22:49:49",
                    "post_content": "<!-- wp:paragraph -->\n<p>Effective 7\/1\/2021: To reach the SelectHealth Foster Care Liaison about a SelectHealth member who is a child in foster care, please use our secure encryption portal. If you are unable to use the secure portal, you can also call <a href=\"tel:1-866-469-7774\">1-866-469-7774<\/a> (TTY: <a href=\"tel:711\">711<\/a>), Monday \u2013 Friday, 9 am \u2013 5 pm, excluding <a rel=\"noreferrer noopener\" href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2020\/12\/2021-VNSNY-Holiday-Schedule.pdf\" target=\"_blank\">holidays<\/a>.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>IMPORTANT: Do not&nbsp;include information about the member in your initial request for access to the portal.<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">For access to the portal:&nbsp;<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list {\"ordered\":true} -->\n<ol><li>When&nbsp;requesting secure communication with the SelectHealth Foster Care Liaison, you will be asked to provide your agency's name, your name, your email address, and your phone number.<br><br>Requests for communication are monitored Monday \u2013 Friday, 9 am \u2013 5 pm, excluding <a rel=\"noreferrer noopener\" href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2020\/12\/2021-VNSNY-Holiday-Schedule.pdf\" target=\"_blank\">holidays<\/a>. All&nbsp;requests will be responded to within two hours. Any request received within two hours of the close of business will be responded to the following morning. Any request received on a weekend or holiday will be responded to the morning of the next business day.<br><br>Note:<strong> You should NOT use this form for urgent issues or emergencies<\/strong>. For urgent issues, call the SelectHealth Foster Care Liaison at <a href=\"tel:1-866-469-7774\">1-866-469-7774<\/a>. If you need to report an emergency, please call 911 immediately.<br><br><a class=\"noExitNotifier\" rel=\"noreferrer noopener\" href=\"https:\/\/forms.office.com\/Pages\/ResponsePage.aspx?id=AL-L0-142E2gZbphh3tPUOt8otVzq3VLg7UbckWGZwBUMDM2UFNMTjkyQ1lWSFlLV0RXV1YyVkUyNS4u\" target=\"_blank\"><u><strong>Use this form<\/strong><\/u><\/a>&nbsp;to request secure communication with the SelectHealth Foster Care Liaison.<br>&nbsp;<\/li><li>Once we've received your initial request, you'll receive an email with an attachment. Open the attachment and click on the link for Office 365 Message Encryption Portal (OME Portal). You will be asked to create an account, if you don't already have one.<br>&nbsp;<\/li><li>Once your&nbsp;OME Portal&nbsp;account has been created, you will be able to communicate with the SelectHealth Foster Care Liaison by hitting \"Reply\" or \"Reply All\" to your response email.&nbsp;All communications through the OME Portal are confidential and are safe for messages that include Protected Health Information about the member.<\/li><\/ol>\n<!-- \/wp:list -->\n\n<!-- wp:paragraph -->\n<p>If you have questions or require assistance setting up your portal account, please call: <a href=\"tel:1-866-469-7774\">1-866-469-7774<\/a>.<\/p>\n<!-- \/wp:paragraph -->",
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                    "post_date": "2020-09-05 19:41:11",
                    "post_date_gmt": "2020-09-05 19:41:11",
                    "post_content": "<!-- wp:paragraph {\"align\":\"left\"} -->\n<p class=\"has-text-align-left\">A new coronavirus \u2014 2019 Novel (New) Coronavirus&nbsp;\u2014&nbsp;&nbsp;that was first detected in China is now spreading worldwide. This virus causes a disease called COVID-19 and can lead to fever, cough, and shortness of breath. There are thousands of confirmed cases in a growing number of countries internationally and the virus is now spreading in the United States. There are ongoing investigations to learn more about this virus.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>VNSNY is committed to helping New Yorkers stay safe and healthy. We have specific procedures in place for staff and patients to help reduce the spread of the COVID-19 coronavirus.&nbsp;<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-what-is-vnsny-doing-to-keep-patients-plan-members-and-the-community-safe\">WHAT IS VNSNY DOING TO KEEP PATIENTS, PLAN MEMBERS, AND THE COMMUNITY SAFE?<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>VNSNY has been working with the New York State Department of Health and the CDC to make sure our patients, staff, and the community we serve are supported against COVID-19.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li><strong>Education.<\/strong>&nbsp;All staff have been trained in minimizing the chances of their becoming infected with COVID-19 and transmitting infection to those they care for, as well as in identifying the symptoms, safety, and screening practices.<\/li><li><strong>Communication.&nbsp;<\/strong>VNSNY has activated its Emergency Response System to provide the most up-to-date information to staff.<\/li><li><strong>Collaboration.<\/strong>&nbsp;We are working closely with the NYC Department of Health and Mental Hygiene, in addition to state and federal agencies and medical facilities, to make sure our procedures and guidelines reflect the most current medical information.<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-for-more-information\">FOR MORE INFORMATION<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>This is a rapidly changing situation. For updates, please see these resource pages for our Members and Providers and from the&nbsp;<a href=\"https:\/\/www.health.ny.gov\/diseases\/communicable\/coronavirus\/\" rel=\"noreferrer noopener\" target=\"_blank\">New York State Department of Health<\/a>&nbsp;and the&nbsp;<a href=\"https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/\" rel=\"noreferrer noopener\" target=\"_blank\">Centers for Disease Control and Prevention<\/a>. New York State has also established a hotline for questions and information:&nbsp;<strong><a href=\"tel:1-888-364-3065\">1-888-364-3065<\/a><\/strong>.<\/p>\n<!-- \/wp:paragraph -->",
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                            "post_date": "2020-09-05 20:48:20",
                            "post_date_gmt": "2020-09-05 20:48:20",
                            "post_content": "<!-- wp:paragraph -->\n<p>See below for important information and helpful resources about COVID-19 for providers who are a part of the VNSNY CHOICE Provider Network.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/faq {\n    \"id\": \"block_5f72790acbf50\",\n    \"name\": \"acf\\\/faq\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_faq_heading\",\n        \"items_0_question\": \"For SelectHealth Providers: Encourage Patients with HIV to Get Vaccinated Against COVID-19\",\n        \"_items_0_question\": \"field_faq_items_question\",\n        \"items_0_answer\": \"<p>Visit our <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/covid-19-information-and-resources\\\/for-hiv-care-providers\\\/\\\">Info &amp; Resources page for HIV Care Providers<\\\/a> for helpful resources\u00a0to use when encouraging patients with HIV to get vaccinated against COVID-19.\u00a0<\\\/p>\",\n        \"_items_0_answer\": \"field_faq_items_answer\",\n        \"items_1_question\": \"For Pharmacy Network Providers: New York Medicaid COVID-19 Vaccine Administration Billing (SelectHealth Only)\",\n        \"_items_1_question\": \"field_faq_items_question\",\n        \"items_1_answer\": \"<p>Please check our <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/02\\\/NY-Medicaid-COVID-19-Vaccine-Administration-Billing.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">billing policy for COVID-19 vaccine <span style=\\\"font-family: 'times new roman', times, serif;\\\">administration<\\\/span><\\\/a><span style=\\\"font-family: 'times new roman', times, serif;\\\">.<\\\/span><\\\/p>\",\n        \"_items_1_answer\": \"field_faq_items_answer\",\n        \"items_2_question\": \"New York State (NYS) Medicaid Billing Guidance for COVID-19 Testing and Specimen Collection at Pharmacies\",\n        \"_items_2_question\": \"field_faq_items_question\",\n        \"items_2_answer\": \"<p>Please check this <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/NYS-Medicaid-COVID-Test-Billing-Guidance_08202020.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">NYS Medicaid billing guidance for COVID-19 testing and specimen collection at pharmacies<\\\/a>.<\\\/p>\",\n        \"_items_2_answer\": \"field_faq_items_answer\",\n        \"items_3_question\": \"Use of Telehealth Services During the COVID-19 Public Health Emergency for CHOICE Total Medicare Providers\",\n        \"_items_3_question\": \"field_faq_items_question\",\n        \"items_3_answer\": \"<p>Effective March 6, 2020, in accordance with CMS guidance, use of telehealth services during COVID-19 is permitted.<\\\/p>\\r\\n<p>VNSNY CHOICE Total (HMO D-SNP) will expand eligibility coverage of telehealth services for CHOICE Total members. This applies to covered services including those provided by primary care doctors, specialists, therapists, and mental health professionals.<\\\/p>\\r\\n<p>While the information below provides billing-related guidance, VNSNY CHOICE Total expects Providers to check the CMS and NYSDOH websites frequently for the latest guidance.<\\\/p>\\r\\n<p><strong>Coding Information<\\\/strong> <br \\\/>\\r\\nCHOICE Total is prepared to accept claims for telehealth services that are consistent with previous announcements when modifiers 95 or GT are appended to CPT or HCPCS codes that ordinarily describe face-to-face services, including but not limited to:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>Professional services related to diagnosis or treatment of COVID-19<\\\/li>\\r\\n\\t<li>Routine care<\\\/li>\\r\\n\\t<li>\u00a0Therapy<\\\/li>\\r\\n\\t<li>Mental Health care through our partner Beacon Health<\\\/li>\\r\\n<\\\/ul>\\r\\n<p>During the current public health emergency, reimbursement for our CHOICE Total members will include services under CMS guidance when provided by our in-network providers using interactive audio and video telecommunications system that permits real-time interactive communication; alternative technologies commonly available on smartphones, tablets, and\\\/or other devices as listed below:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>Telehealth Services (Both synchronous audio and visual required)<\\\/li>\\r\\n\\t<li>Online Patient Portal Communication (Patient-initiated virtual check-ins)<\\\/li>\\r\\n<\\\/ul>\\r\\n<p>For Telehealth services rendered, the provider should bill as follows:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>Use CMS designated place of service (POS) \u201802\u2019.<\\\/li>\\r\\n\\t<li>Use CMS designated CPT telehealth modifier \u201895\u2019 with any place of service, or \u2018GT\u2019 to the appropriate embed link to these procedure codes. NOTE: This list of services is furnished by the current CMS guidelines and subject to updates and changes by CMS.<\\\/li>\\r\\n\\t<li>Follow current coding guidelines set forth by the American Medical Assistance, Current Procedural Terminology Professional Edition and associated publications and services.<\\\/li>\\r\\n<\\\/ul>\\r\\n<p><strong>Important links for Medicare Providers:<\\\/strong><\\\/p>\\r\\n<ul>\\r\\n\\t<li>CMS Fact Sheet on Medicare Telemedicine<\\\/li>\\r\\n\\t<li>CMS Frequently Asked Questions on Telehealth<\\\/li>\\r\\n\\t<li>\u00a0Waiver or Modification of Requirements Under Section 1135 of the SSA<\\\/li>\\r\\n\\t<li>\u00a0CMS Provider-Specific Telehealth Fact Sheet NYS DOH Guidance for Medicaid Telehealth<\\\/li>\\r\\n\\t<li>\u00a0CHOICE eblast on Medicaid Telehealth during the COVID-19 Emergency, sent 3\\\/27<\\\/li>\\r\\n\\t<li>NYS DOH Medicaid Guidance for Providers<\\\/li>\\r\\n\\t<li>See Medicaid Telehealth FAQs<\\\/li>\\r\\n<\\\/ul>\\r\\n<p><strong>Behavioral Health<\\\/strong> <br \\\/>\\r\\nDuring this national public health emergency, our partner Beacon Health is issuing new policies to serve our members and ensure access to care.<\\\/p>\\r\\n<p>Please visit <a href=\\\"http:\\\/\\\/www.beaconhealthoptions.com\\\/coronavirus\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">www.beaconhealthoptions.com\\\/coronavirus<\\\/a> for the latest updates.<\\\/p>\\r\\n<p>For questions related to coverage and billing at VNSNY CHOICE Health Plans, please call your dedicated Provider Relations representative.<\\\/p>\\r\\n<p>Or call VNSNY CHOICE Provider Services toll free: <a href=\\\"tel:1-866-783-0222\\\">1-866-783-0222<\\\/a>. TTY for the hearing impaired: <a href=\\\"tel:711\\\">711<\\\/a>.<\\\/p>\",\n        \"_items_3_answer\": \"field_faq_items_answer\",\n        \"items_4_question\": \"Use of Telehealth During the COVID-19 State of Emergency\",\n        \"_items_4_question\": \"field_faq_items_question\",\n        \"items_4_answer\": \"<p>Effective March 1, 2020, in accordance with published New York State Department of Health (NYS DOH) Medicaid Guidance, all VNSNY CHOICE Health Plans\u2014CHOICE MLTC, CHOICE Total (HMO D-SNP), and SelectHealth\u2014will expand eligibility for coverage of telehealth services to all members.<\\\/p>\\r\\n<p>In line with this guidance, CHOICE will reimburse providers for telephonic assessment, monitoring, and evaluation and management services provided to members where face-to-face visits may not be recommended and it is appropriate for the member to be evaluated and managed by telephone.<\\\/p>\\r\\n<p>Telehealth is the use of electronic information and communication technologies (computer, smartphone or tablet) to deliver health care to patients at a distance.<\\\/p>\\r\\n<p>For purposes of the State of Emergency, this definition is expanded to include telephone conversations.<\\\/p>\\r\\n<p>Medicaid covered services provided via telehealth include:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>\u00a0assessment<\\\/li>\\r\\n\\t<li>\u00a0diagnosis<\\\/li>\\r\\n\\t<li>\u00a0consultation<\\\/li>\\r\\n\\t<li>\u00a0treatment<\\\/li>\\r\\n\\t<li>\u00a0education<\\\/li>\\r\\n\\t<li>care management and\\\/or self-management<\\\/li>\\r\\n<\\\/ul>\\r\\n<p>This applies to all contracted providers serving members under VNSNY CHOICE Health Plans. All telephonic encounters documented as appropriate by the provider would be considered medically necessary for payment purposes.<\\\/p>\\r\\n<p>All other requirements in delivery of these services otherwise apply.<\\\/p>\\r\\n<p>For more information about how to bill or code for telehealth services, please see this telephonic reimbursement overview from the DOH.<\\\/p>\\r\\n<p><strong>Behavioral Health<\\\/strong> <br \\\/>\\r\\nDuring this national public health emergency, our partner Beacon Health is issuing new policies to serve our members and ensure access to care.<\\\/p>\\r\\n<p>Please visit <a href=\\\"http:\\\/\\\/www.beaconhealthoptions.com\\\/coronavirus\\\">www.beaconhealthoptions.com\\\/coronavirus<\\\/a> for the latest updates.<\\\/p>\\r\\n<p><strong>Access to Telehealth Equipment and Digital Services <br \\\/>\\r\\n<\\\/strong>If you have patients who are VNSNY CHOICE Health Plan Members who need WiFi, data coverage and\\\/or a cell phone, please see the DOH's Medicaid Guidance on Telehealth from March 23.<\\\/p>\",\n        \"_items_4_answer\": \"field_faq_items_answer\",\n        \"items_5_question\": \"COVID-19 Guidance for Medicaid Providers \",\n        \"_items_5_question\": \"field_faq_items_question\",\n        \"items_5_answer\": \"<p>Please check the following resources with guidance for New York Medicaid providers.<\\\/p>\\r\\n<ul>\\r\\n\\t<li>The New York State Department of Health (DOH) posts guidance and resources here.<\\\/li>\\r\\n\\t<li>\u00a0DOH also has a Coronavirus Provider Information Page.<\\\/li>\\r\\n\\t<li>\u00a0The 2020 DOH Medicaid Updates, including COVID-19 special editions, are posted here.<\\\/li>\\r\\n\\t<li>DOH has published the following contact information for Providers:\\r\\n\\r\\n<ul>\\r\\n\\t<li>Questions about COVID-19 can be directed to ipc@health.ny.gov or the toll-free call center at 888-364-3065.<\\\/li>\\r\\n\\t<li>Questions about guidance relating to COVID-19 may be sent to OMCMail@health.ny.gov.<\\\/li>\\r\\n<\\\/ul>\\r\\n<\\\/li>\\r\\n\\t<li>You can find Medicaid guidance from CMS on their Medicaid.gov Disaster Page.<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_5_answer\": \"field_faq_items_answer\",\n        \"items_6_question\": \"Guidance for Medicare Providers\",\n        \"_items_6_question\": \"field_faq_items_question\",\n        \"items_6_answer\": \"<p>Please check the following resources with guidance for Medicare providers.<\\\/p>\\r\\n<ul>\\r\\n\\t<li>CMS posts COVID-19 guidance on its Current Emergencies page.<\\\/li>\\r\\n\\t<li>You can also find information in the CMS newsroom.<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_6_answer\": \"field_faq_items_answer\",\n        \"items_7_question\": \"Behavioral Health Update for Providers with members of CHOICE Total and SelectHealth \",\n        \"_items_7_question\": \"field_faq_items_question\",\n        \"items_7_answer\": \"<p>During this national public health emergency, Beacon is issuing new policies to serve our members and ensure access to care.<\\\/p>\\r\\n<p>Please visit\u00a0<a href=\\\"https:\\\/\\\/www.beaconhealthoptions.com\\\/coronavirus\\\/\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">https:\\\/\\\/www.beaconhealthoptions.com\\\/coronavirus<\\\/a> and <a href=\\\"https:\\\/\\\/www.beaconhealthoptions.com\\\/coronavirus\\\/provider-resources\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">https:\\\/\\\/www.beaconhealthoptions.com\\\/coronavirus\\\/provider-resources<\\\/a> for the latest updates.<\\\/p>\",\n        \"_items_7_answer\": \"field_faq_items_answer\",\n        \"items_8_question\": \"Preparedness Strategies for Providers \",\n        \"_items_8_question\": \"field_faq_items_question\",\n        \"items_8_answer\": \"<p>As you are most likely aware, in late 2019, a new coronavirus was identified as\u00a0the cause of an outbreak of acute respiratory illness (COVID-19) in Wuhan,\u00a0China. Since then, an increasing number of COVID-19 cases have been\u00a0reported in other countries, including the United States, and now in New York\u00a0State. The purpose of this guidance is to instruct providers to develop and\u00a0implement strategies for COVID-19 preparedness that ensures timely member\u00a0access to all relevant information and needed health care services.<\\\/p>\\r\\n<p>Additional guidance will be forthcoming as testing capabilities are\u00a0expanded and other information becomes available. An emergency declaration\u00a0may require changes to this guidance. At this time, providers\u2019 COVID-19\u00a0preparedness strategies should include, at a minimum, the following\u00a0components:<\\\/p>\\r\\n<p><strong>An emergency preparedness plan:<\\\/strong> <br \\\/>\\r\\nReview and update your internal emergency preparedness plan to ensure infrastructure stability and business continuity so that members' care is uninterrupted in the event of the further spread of COVID-19 in New York.\u00a0 <br \\\/>\\r\\n<br \\\/>\\r\\n<strong>Proper Aide and Member guidance and education:<\\\/strong> <br \\\/>\\r\\nHome Health agencies must implement processes to provide information and resources to Aides on how to protect themselves and minimize transmission of the virus and help members understand how and when to access services for COVID-19 care. Any member-related questions should be addressed with their VNSNY CHOICE Care Manager.<\\\/p>\\r\\n<p>If an emergency is declared, this information could change or be added to. We\u00a0will keep you informed as we learn more.\u00a0Thank you for your attention and action on this important matter.<\\\/p>\\r\\n<p>The Department of Health provides public health information and guidance, here: <a href=\\\"https:\\\/\\\/www.health.ny.gov\\\/diseases\\\/communicable\\\/coronavirus\\\/\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">https:\\\/\\\/www.health.ny.gov\\\/diseases\\\/communicable\\\/coronavirus<\\\/a>, and has\u00a0implemented a Novel Coronavirus Hotline at\u00a0<strong><a href=\\\"tel:1-888-364-3065\\\">1-888-364-3065<\\\/a><\\\/strong>.<\\\/p>\\r\\n<p>The Centers for Disease Control\u2019s website offers up to date information at:\u00a0<a href=\\\"https:\\\/\\\/www.cdc.gov\\\/coronavirus\\\/2019-ncov\\\/index.html\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">https:\\\/\\\/www.cdc.gov\\\/coronavirus\\\/2019-ncov\\\/index.html<\\\/a>.\u00a0<\\\/p>\\r\\n<p>If you have any questions, please contact\u00a0<a href=\\\"mailto:omcmail@health.ny.gov\\\">omcmail@health.ny.gov<\\\/a>.<\\\/p>\",\n        \"_items_8_answer\": \"field_faq_items_answer\",\n        \"items\": 9,\n        \"_items\": \"field_faq_items\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:paragraph -->\n<p>The Department of Health provides public health information and guidance, here: <a rel=\"noreferrer noopener\" href=\"https:\/\/www.health.ny.gov\/diseases\/communicable\/coronavirus\/\" target=\"_blank\">https:\/\/www.health.ny.gov\/diseases\/communicable\/coronavirus<\/a>, and has&nbsp;implemented a Novel Coronavirus Hotline at&nbsp;<strong><a href=\"tel:1-888-364-3065\">1-888-364-3065<\/a><\/strong>.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>The Centers for Disease Control\u2019s website offers up to date information at:&nbsp;<a href=\"https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/index.html\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/index.html<\/a>.&nbsp;<\/p>\n<!-- \/wp:paragraph -->",
                            "post_title": "COVID-19 Info & Resources for CHOICE Providers",
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                            "post_modified": "2021-06-14 13:19:12",
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                        {
                            "ID": 3427,
                            "post_author": "6",
                            "post_date": "2020-09-05 20:35:51",
                            "post_date_gmt": "2020-09-05 20:35:51",
                            "post_content": "<!-- wp:paragraph -->\n<p>The following is a&nbsp;<a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2021\/02\/NYC-Health-Department-Provider-Letter_COVID-19-Vaccines-for-People-with-HIV.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">message<\/a>&nbsp;from&nbsp;Sarah L. Braunstein, PhD, MPH, Acting Assistant Commissioner and Director, HIV Epidemiology, Bureau of HIV New York City Department of Health and Mental Hygiene.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>All people with HIV who live in New York State (NYS) are now eligible to receive the COVID-19 vaccine. For a list of groups currently eligible for the COVID-19 vaccine in NYS, visit <a href=\"http:\/\/nyc.gov\/covidvaccinedistribution\" target=\"_blank\" rel=\"noreferrer noopener\">nyc.gov\/covidvaccinedistribution<\/a>.<br><br>Encourage patients with HIV to get vaccinated against COVID-19. People with HIV are a priority for vaccination, as many have comorbidities that increase risk of severe COVID-19 and face socioeconomic conditions that may increase risk of exposure. A provider\u2019s recommendation is one of the strongest predictors of a patient receiving a vaccine. Reach out to patients with HIV and help them get access to COVID-19 vaccine.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:table -->\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Resources for Your Patients<\/strong><\/td><\/tr><tr><td>Please feel free to share this <a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2021\/02\/NYC-Health-Department-Guidance-for-People-with-HIV-on-COVID-19-Vaccines.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">guidance from the Department of Health<\/a> with patients who are living with HIV. <\/td><\/tr><\/tbody><\/table><\/figure>\n<!-- \/wp:table -->\n\n<!-- wp:paragraph -->\n<p>Help eligible patients get vaccinated against COVID-19. If your facility has received vaccine, offer vaccination to eligible patients. Assist patients to navigate the vaccine appointment systems of the NYC Department of Health and Mental Hygiene (NYC Health Department) at <a href=\"http:\/\/vax4nyc.nyc.gov\" target=\"_blank\" rel=\"noreferrer noopener\">vax4nyc.nyc.gov<\/a>, NYC Health + Hospitals and NYS. New Yorkers can find a vaccination site and make an appointment at <a href=\"http:\/\/vaccinefinder.nyc.gov\" target=\"_blank\" rel=\"noreferrer noopener\">vaccinefinder.nyc.gov<\/a>. If they need assistance making an appointment at a City-run site, they can call <a href=\"tel:877-829-4692\">877-VAX-4NYC<\/a> (<a href=\"tel:877-829-4692\">877-829-4692<\/a>). Inform patients that vaccine supplies are limited. Encourage them to check regularly as new appointments will be added as more vaccine becomes available.<br><br>Patients need to bring proof that they live in NYS or NYC and are eligible for the COVID-19 vaccine. If they are eligible because they have HIV and are being vaccinated by their health care provider, their medical records can serve as proof of eligibility. Otherwise, when scheduling an appointment, patients will need to complete a certification confirming they have an underlying health condition that makes them eligible for vaccination. They do not need to state which health condition or provide any other evidence to demonstrate which condition they have. For more information on proof of eligibility, visit <a href=\"http:\/\/nyc.gov\/covidvaccine\" target=\"_blank\" rel=\"noreferrer noopener\">nyc.gov\/covidvaccine<\/a>.<br><br>HIV care providers do not need to clear their patients to receive the COVID-19 vaccine. Currently, the Moderna and Pfizer-BioNTech vaccines are only contraindicated by history of allergic reaction to the vaccine, one of its components or polysorbate. Clinical trials established the general safety and efficacy of these vaccines, but only the Moderna trial included people with HIV. Following Centers for Disease Control and Prevention guidance, inform patients that we lack sufficient data on vaccine safety or effectiveness specific to people with HIV and people who are immunocompromised. Counsel immunocompromised people (including people with HIV with low CD4 counts) that because we do not know whether the vaccine will work as well for them, they should be especially cautious to avoid potential exposure to COVID-19, even after vaccination.<br><br>Continue to engage patients in HIV care and other necessary health care. Immunocompromised people may be at increased risk of severe COVID-19. While New Yorkers should limit activities outside the home, no one should forgo regular HIV care or other necessary care. Make sure patients with HIV are screened for viral load and CD4 count at least every six months and have regular opportunities to discuss any barriers to care. HIV care clinics can provide some care through telehealth or video chat. See guidance for providers of HIV services during COVID-19 from the NYC Health Department and the U.S. Department of Health and Human Services.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Ensure equal access to care. HIV and COVID-19 disproportionately affect communities of color. In NYC, 86% of people with HIV diagnosed with COVID-19 are Black or Latino, and these groups have greater mortality associated with HIV and with COVID-19. Furthermore, in NYC, Black and Latino people are less likely to have received a COVID-19 vaccine. Counsel patients with HIV, particularly those who are Black or Latino, that COVID-19 vaccines are safe and effective and provide critical protection for their health<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>For more information on COVID-19, visit <a href=\"http:\/\/nyc.gov\/health\/coronavirus\" target=\"_blank\" rel=\"noreferrer noopener\">nyc.gov\/health\/coronavirus<\/a>. Select \u201cInformation for Providers\u201d for Dear Colleague updates, health alerts and advisories, webinars and other resources.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:table -->\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Novel Coronavirus and People with HIV<\/strong><\/td><\/tr><tr><td>Please download this&nbsp;<a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2020\/09\/Letter-to-HIV-Care-Providers.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">message<\/a>&nbsp;from&nbsp;Oni Blackstock, MD, MHS Assistant Commissioner Bureau of HIV,&nbsp;New York City Department of Health and Mental Hygiene and Charles Gonzalez, MD Medical Director&nbsp;AIDS Institute&nbsp;New York State Department of Health.<br><\/td><\/tr><\/tbody><\/table><\/figure>\n<!-- \/wp:table -->",
                            "post_title": "COVID-19 INFO & RESOURCES FOR HIV CARE PROVIDERS",
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                            "post_modified": "2021-02-19 14:37:04",
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                        {
                            "ID": 3421,
                            "post_author": "6",
                            "post_date": "2020-09-05 19:56:07",
                            "post_date_gmt": "2020-09-05 19:56:07",
                            "post_content": "<!-- wp:paragraph -->\n<p>See below for important information and helpful resources about COVID-19 for members of VNSNY CHOICE Health Plans. (<a class=\"noExitNotifier\" href=\"https:\/\/www.selecthealthny.org\/covid-19-information-and-resources\/\">Members of SelectHealth can find more information, here<\/a>.)<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/faq {\n    \"id\": \"block_5f614f9302249\",\n    \"name\": \"acf\\\/faq\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_faq_heading\",\n        \"items_0_question\": \"What is the difference between coronavirus and COVID-19?\",\n        \"_items_0_question\": \"field_faq_items_question\",\n        \"items_0_answer\": \"Coronavirus is a term for a group of viruses. Four types of coronavirus cause the common cold. COVID-19 is a disease caused by a coronavirus.\",\n        \"_items_0_answer\": \"field_faq_items_answer\",\n        \"items_1_question\": \"Who is at risk from COVID-19?\",\n        \"_items_1_question\": \"field_faq_items_question\",\n        \"items_1_answer\": \"According to the Centers for Disease Control and Prevention (CDC), people at high risk for developing a more serious case of COVID-19 are older adults and those with chronic medical conditions like heart, lung, or kidney disease.\",\n        \"_items_1_answer\": \"field_faq_items_answer\",\n        \"items_2_question\": \"What are the symptoms of COVID-19?\",\n        \"_items_2_question\": \"field_faq_items_question\",\n        \"items_2_answer\": \"Symptoms of COVID-19 include a fever, cough, and shortness of breath. The CDC believes that symptoms can appear two to 14 days after exposure. Mild cases may seem like a cold or a lower respiratory illness, such as bronchitis. In those with weakened immune systems, including people with chronic illness and the elderly, the virus can cause severe symptoms. These may include difficulty breathing, and high fever and may lead to pneumonia or other severe infections.\",\n        \"_items_2_answer\": \"field_faq_items_answer\",\n        \"items_3_question\": \"What should I do if I think I might have COVID-19?\",\n        \"_items_3_question\": \"field_faq_items_question\",\n        \"items_3_answer\": \"The most important thing is to stay calm.\u00a0<strong>If you develop a fever, cough, or other signs you may have COVID-19 infection, you should immediately contact your doctor and\\\/or local medical center to discuss whether you should get test\u00aded for the virus.<\\\/strong>\",\n        \"_items_3_answer\": \"field_faq_items_answer\",\n        \"items_4_question\": \"What can I do to avoid catching and spreading COVID-19?\",\n        \"_items_4_question\": \"field_faq_items_question\",\n        \"items_4_answer\": \"The best way to prevent illness is to avoid being exposed to this virus, including:\\r\\n<ul>\\r\\n \\t<li>Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing.<\\\/li>\\r\\n \\t<li>Clean and disinfect frequently touched objects and surfaces.<\\\/li>\\r\\n \\t<li>\u00a0Follow social distancing recommendations, remaining six feet away from all individuals aside from those in your household.<\\\/li>\\r\\n \\t<li>\u00a0Avoid close contact with people who are sick (stay at least six feet away if possible).<\\\/li>\\r\\n \\t<li>\u00a0Please note that the CDC is advising individuals to stay home when you are sick, particularly if you are experiencing the symptoms of potential COVID-19 infection as described above: fever, cough, and shortness of breath.<\\\/li>\\r\\n \\t<li>\u00a0Avoid touching your eyes, nose, and mouth, especially with unwashed hands.<\\\/li>\\r\\n \\t<li>\u00a0The New York City Department of Health recommends wearing a face covering (such as a scarf, dust mask, or bandana) when out in public. Ideally, wear a clean face covering every day. Please conserve medical-grade masks for our health care workers.<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_4_answer\": \"field_faq_items_answer\",\n        \"items_5_question\": \"Where can I find behavioral health resources?\",\n        \"_items_5_question\": \"field_faq_items_question\",\n        \"items_5_answer\": \"During this national public health emergency, Beacon is issuing new policies to serve our members and ensure access to care. VNSNY CHOICE Total members can visit <a href=\\\"https:\\\/\\\/www.beaconhealthoptions.com\\\/coronavirus\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">https:\\\/\\\/www.beaconhealthoptions.com\\\/coronavirus<\\\/a> for the latest updates.\",\n        \"_items_5_answer\": \"field_faq_items_answer\",\n        \"items_6_question\": \"Where can I find more information? \",\n        \"_items_6_question\": \"field_faq_items_question\",\n        \"items_6_answer\": \"This is a rapidly changing situation. For updates, please see these resource pages from the\u00a0<a href=\\\"https:\\\/\\\/www.health.ny.gov\\\/diseases\\\/communicable\\\/coronavirus\\\/\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">New York State Department of Health<\\\/a>\u00a0and the\u00a0<a href=\\\"https:\\\/\\\/www.cdc.gov\\\/coronavirus\\\/2019-ncov\\\/\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Centers for Disease Control and Prevention<\\\/a>. New York State has also established a hotline for questions and information:\u00a0<strong><a href=\\\"tel:1-888-364-3065\\\">1-888-364-3065<\\\/a><\\\/strong>.\",\n        \"_items_6_answer\": \"field_faq_items_answer\",\n        \"items\": 7,\n        \"_items\": \"field_faq_items\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:core-embed\/youtube {\"url\":\"https:\/\/www.youtube.com\/embed\/d914EnpU4Fo\",\"type\":\"rich\",\"providerNameSlug\":\"embed-handler\",\"className\":\"wp-embed-aspect-16-9 wp-has-aspect-ratio\"} -->\n<figure class=\"wp-block-embed-youtube wp-block-embed is-type-rich is-provider-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\nhttps:\/\/www.youtube.com\/embed\/d914EnpU4Fo\n<\/div><\/figure>\n<!-- \/wp:core-embed\/youtube -->",
                            "post_title": "COVID-19 Resources For CHOICE Members",
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                            "ID": 8251,
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                            "post_date": "2021-02-23 19:11:34",
                            "post_date_gmt": "2021-02-24 00:11:34",
                            "post_content": "<!-- wp:paragraph -->\n<p>You may have questions about the COVID-19 vaccines. Is it safe to get the vaccine? What about side effects? You may be unsure if it really works\u2014or question how well it works.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>At VNSNY, we take seriously our mission of protecting the health of our community. We want to make sure our patients and plan members have the best care possible. We also work hard to ensure our employees and our neighbors are safe and healthy as well.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>If you are not sure if the vaccine is right for you, we understand. Here is important information about the COVID-19 vaccines as you decide.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-the-covid-19-vaccines-work\">The COVID-19 vaccines work.<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>The COVID vaccines work very well to protect people from getting sick with COVID-19. The Moderna and Pfizer vaccines are given in two doses. The first shot kicks your immune system up to a certain level. The second shot kicks it to an even higher level. The doses need to be a few weeks apart to give your body time to reach that first level. In studies, one dose of the vaccine was 50% effective in preventing COVID-19. After two doses, both vaccines were more than 94% effective.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>In addition, people who are vaccinated are less likely to make other people sick. Getting the vaccine protects you and the people you care about.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-the-covid-19-vaccines-are-safe\">The COVID-19 vaccines are safe. <\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>Many countries and many companies worked together to develop the COVID-19 vaccines. The different vaccines went through extensive studies and trials. The FDA and safety boards reviewed data from these trials at every stage.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-you-won-t-get-sick-from-the-vaccine\">You won't get sick from the vaccine. <\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>Neither vaccine contains COVID-19 so you won\u2019t get sick from it. However, some people have side effects after they get the vaccine. The most common side effects are:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>Soreness at the injection spot<\/li><li>Slight fever<\/li><li>Tiredness<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:paragraph -->\n<p>These side effects are a sign that the vaccine is working! They show that your body is building protection against the virus. Side effects usually go away after a few days.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Serious side effects are very rare (about 5 people in 1,000 have a bad reaction). More than 30 million Americans have received at least one dose of the vaccine. There have been only 100 reported cases of a serious reaction.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-how-does-the-covid-19-vaccine-work\">How does the COVID-19 vaccine work?<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>The vaccine tricks your body into thinking you have COVID-19. This kicks your immune system into action to fight the virus. Then, if you are exposed to COVID-19, your immune system recognizes the virus. It knows how to attack and destroy it, so the virus can\u2019t make you sick.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-you-need-two-shots-of-the-pfizer-or-moderna-vaccine-three-or-four-weeks-apart\">You need two shots of the Pfizer or Moderna vaccine, three or four weeks apart. <\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>Studies and vaccine trials were done on two doses of the vaccine. We don\u2019t know how effective one dose is, so it is very important that you get both doses of the same vaccine, to be fully protected.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-for-more-information\">For more information <\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>We encourage people to get the vaccine as soon as they are eligible. For information about eligibility and making an appointment to get the vaccine:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3>New York City residents should call or visit<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:list -->\n<ul><li>NYC Vaccine Hotline: 1-877-VAX-4NYC (<a href=\"tel:1-877-829-4962\">1-877-829-4692<\/a>)<\/li><li><a href=\"https:\/\/www1.nyc.gov\/site\/doh\/covid\/covid-19-vaccines.page\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www1.nyc.gov\/site\/doh\/covid\/covid-19-vaccines.page<\/a><\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3>New York State residents should call or visit<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:list -->\n<ul><li>New York State COVID-19 Vaccination Hotline: 1-833-NYS-4-VAX (<a href=\"tel:1-833-697-4829\">1-833-697-4829<\/a>)<\/li><li><a href=\"https:\/\/covid19vaccine.health.ny.gov\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/covid19vaccine.health.ny.gov\/<\/a><\/li><\/ul>\n<!-- \/wp:list -->",
                            "post_title": "Information About the COVID-19 Vaccine",
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                {
                    "ID": 448,
                    "post_author": "3",
                    "post_date": "2020-07-22 17:49:58",
                    "post_date_gmt": "2020-07-22 17:49:58",
                    "post_content": "<!-- wp:acf\/hero {\n    \"id\": \"block_5f189b8757435\",\n    \"name\": \"acf\\\/hero\",\n    \"data\": {\n        \"background_image_image\": \"\",\n        \"_background_image_image\": \"field_hero_background_image_image\",\n        \"background_image_caption\": \"\",\n        \"_background_image_caption\": \"field_hero_background_image_caption\",\n        \"background_image\": \"\",\n        \"_background_image\": \"field_hero_background_image\",\n        \"heading\": \"Find a Doctor\",\n        \"_heading\": \"field_hero_heading\",\n        \"subheading\": \"Pick your plan below to find a provider in your network. \",\n        \"_subheading\": \"field_hero_subheading\",\n        \"text\": \"\",\n        \"_text\": \"field_hero_text\",\n        \"button\": \"\",\n        \"_button\": \"field_hero_button\"\n    },\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:acf\/plan-set {\n    \"id\": \"block_5f187c5691cbf\",\n    \"name\": \"acf\\\/plan-set\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_plan-set_heading\",\n        \"subheading\": \"\",\n        \"_subheading\": \"field_plan-set_subheading\",\n        \"bottom_plan_active\": \"0\",\n        \"_bottom_plan_active\": \"field_plan-set_bottom_plan_active\",\n        \"cards_0_heading\": \"VNSNY CHOICE Total (HMO D-SNP)\",\n        \"_cards_0_heading\": \"field_plan-set_cards_heading\",\n        \"cards_0_description\": \"A Medicare Advantage plan and a Medicaid Advantage Plus plan. Brings together Medicare and Medicaid Long Term Care benefits in one plan for people who need long-term help with daily activities.\\r\\n\\r\\nFor current members with questions, you can call us at <a href=\\\"tel:1-866-783-1444\\\">1-866-783-1444<\\\/a>, 8 am \u2013 8 pm, 7 days a week. TTY: <a href=\\\"tel:711\\\">711<\\\/a>.\\r\\n\\r\\nIf you are not yet a member and have questions, call us at <a href=\\\"tel:1-718-424-6423\\\">1-718-4CHOICE<\\\/a> (<a href=\\\"tel:1-718-424-6423\\\">1-718-424-6423<\\\/a>), 8 am \u2013 8 pm, 7 days a week. TTY: <a href=\\\"tel:711\\\">711<\\\/a>.\",\n        \"_cards_0_description\": \"field_plan-set_cards_description\",\n        \"cards_0_button\": {\n            \"title\": \"Go to Total Provider Search\",\n            \"url\": \"https:\\\/\\\/providersearch.vnsnychoice.org\\\/#\\\/?plan=map\",\n            \"target\": \"_blank\"\n        },\n        \"_cards_0_button\": \"field_plan-set_cards_button\",\n        \"cards_0_disable_exit_notifier\": \"0\",\n        \"_cards_0_disable_exit_notifier\": \"field_plan-set_cards_disable_exit_notifier\",\n        \"cards_0_rich_text\": \"<p>VNSNY CHOICE Total has a network of thousands of providers, including medical doctors (primary care physicians and specialists) and nurse practitioners, as well as hospitals, health centers, nursing homes, and other providers.<\\\/p>\\r\\n<p><a href=\\\"\\\/choice-total-2020-provider-and-pharmacy-directory-intro\\\/\\\">Check here for more information about the VNSNY CHOICE Total Provider and Pharmacy Directory<\\\/a>.<\\\/p>\\r\\n<p>Certain pharmacies are not available to all members (Home Infusion, Long-Term Care, Indian Health and Specialty). If you are a TTY\\\/TDD user and are trying to reach a pharmacy in our network, please contact the New York State Relay Service and an operator will connect you. This pharmacy listing does not guarantee that the pharmacy is still in the network. Please contact us for more information about the pharmacies in our network.<\\\/p>\\r\\n<p>If you don\u2019t see the doctor, hospital, or ancillary provider you are looking for, please call us. You can also call to let us know about any information in the directory that is not correct so that we can update it.<\\\/p>\",\n        \"_cards_0_rich_text\": \"field_plan-set_cards_rich_text\",\n        \"cards_1_heading\": \"VNSNY CHOICE MLTC \",\n        \"_cards_1_heading\": \"field_plan-set_cards_heading\",\n        \"cards_1_description\": \"A Medicaid Managed Long Term Care plan. Provides long-term help with daily activities for people who are not eligible for Medicare or want to keep it separate.\\r\\n\\r\\nFor current members with questions, you can call us at <a href=\\\"tel:1-866-783-1444\\\">1-888-VNS-6555<\\\/a> (<a href=\\\"tel:18888676555\\\">1-888-867-6555<\\\/a>), 9 am \u2013 5 pm, Monday \u2013 Friday. TTY: 711.\\r\\n\\r\\nIf you are not yet a member and have questions, call us at <a href=\\\"tel:1-855-282-4642\\\">1-855-AT CHOICE<\\\/a> (<a href=\\\"tel:1-855-282-4642\\\">1-855-282-4642<\\\/a>), 9 am \u2013 5 pm, Monday \u2013 Friday. TTY: 711.\",\n        \"_cards_1_description\": \"field_plan-set_cards_description\",\n        \"cards_1_button\": {\n            \"title\": \"Go to MLTC Provider Search\",\n            \"url\": \"https:\\\/\\\/providersearch.vnsnychoice.org\\\/#\\\/?plan=mltc\",\n            \"target\": \"_blank\"\n        },\n        \"_cards_1_button\": \"field_plan-set_cards_button\",\n        \"cards_1_disable_exit_notifier\": \"0\",\n        \"_cards_1_disable_exit_notifier\": \"field_plan-set_cards_disable_exit_notifier\",\n        \"cards_1_rich_text\": \"VNSNY CHOICE MLTC members can continue seeing their current doctors and are not required to choose network physicians. CHOICE uses a network of community providers to deliver many other services our MLTC members need. 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                    "post_title": "Find a Doctor",
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                {
                    "ID": 6552,
                    "post_author": "6",
                    "post_date": "2020-11-25 12:55:13",
                    "post_date_gmt": "2020-11-25 17:55:13",
                    "post_content": "<!-- wp:paragraph -->\n<p><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/faq {\n    \"id\": \"block_5fbe986f847e1\",\n    \"name\": \"acf\\\/faq\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_faq_heading\",\n        \"items_0_question\": \"What is the Inovalon Virtual Health Visit? \",\n        \"_items_0_question\": \"field_faq_items_question\",\n        \"items_0_answer\": \"The Virtual Health Visit is a medical appointment you can have from home using your computer, smartphone, or tablet, making it possible to speak with a healthcare provider in a different location. VNSNY CHOICE Total (HMO D-SNP) partners with a company called Inovalon that makes their healthcare providers available for these Virtual Health Visits with you.\",\n        \"_items_0_answer\": \"field_faq_items_answer\",\n        \"items_1_question\": \"How much does a Virtual Health Visit cost? \",\n        \"_items_1_question\": \"field_faq_items_question\",\n        \"items_1_answer\": \"There is no out-of-pocket cost to you. Virtual Health Visits are a benefit of your membership in CHOICE Total.\",\n        \"_items_1_answer\": \"field_faq_items_answer\",\n        \"items_2_question\": \"Why might I need to have a Virtual Health Visit?\",\n        \"_items_2_question\": \"field_faq_items_question\",\n        \"items_2_answer\": \"A Virtual Health Visit lets you meet with an Inovalon healthcare provider to talk about your health history, your medications, and any health concerns that you may have.\u00a0 You will still need to see your own doctors in person for tests, screenings, shots, and other procedures that you normally get. A Virtual Health Visit is good when you do not need a procedure but just need to speak with a provider about your health.\",\n        \"_items_2_answer\": \"field_faq_items_answer\",\n        \"items_3_question\": \"Do I need to worry about my privacy during a Virtual Health Visit? \",\n        \"_items_3_question\": \"field_faq_items_question\",\n        \"items_3_answer\": \"No, you do not. Each visit is protected and secure. In addition, Inovalon is bound by HIPAA (the Health Insurance Portability and Accountability Act) to protect, preserve, and maintain the confidentiality of any protected health information you share with providers.\",\n        \"_items_3_answer\": \"field_faq_items_answer\",\n        \"items_4_question\": \"How do I join a Virtual Health Visit? \",\n        \"_items_4_question\": \"field_faq_items_question\",\n        \"items_4_answer\": \"You can join using your computer or tablet (such as an iPad), or with your iPhone or Android smartphone. When you sign up for a visit, you will be sent a link. Before your appointment, click on the link, which will take you to an online \u201cwaiting room.\u201d\u00a0 The doctor will start your visit at the scheduled time.\",\n        \"_items_4_answer\": \"field_faq_items_answer\",\n        \"items_5_question\": \"Do I need to download any special software or programs? \",\n        \"_items_5_question\": \"field_faq_items_question\",\n        \"items_5_answer\": \"If you are using a laptop or a desktop computer, no download is needed. When using your smartphone or tablet for your first visit, you may be prompted to download Google Meet if you don\u2019t already have that app. In that case, you will need to go to the <a href=\\\"https:\\\/\\\/apps.apple.com\\\/us\\\/app\\\/google-meet\\\/id1013231476\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">iPhone App Store<\\\/a> or <a href=\\\"https:\\\/\\\/play.google.com\\\/store\\\/apps\\\/details?id=com.google.android.apps.meetings&amp;hl=en_US&amp;gl=US\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Google Play<\\\/a> for Android phones. You will just need to enter your password to begin the download. The app is free.\",\n        \"_items_5_answer\": \"field_faq_items_answer\",\n        \"items_6_question\": \"How should I prepare for my scheduled Virtual Health Visit? \",\n        \"_items_6_question\": \"field_faq_items_question\",\n        \"items_6_answer\": \"The Inovalon provider will ask you about your health history, review your medications, and discuss any health concerns that you may have. It\u2019s a good idea to have a list of your current medications in front of you. You should also tell the provider if you are using any monitoring devices to manage your chronic health conditions.\",\n        \"_items_6_answer\": \"field_faq_items_answer\",\n        \"items_7_question\": \"When should I go to my scheduled Virtual Health Visit appointment? \",\n        \"_items_7_question\": \"field_faq_items_question\",\n        \"items_7_answer\": \"Please plan to join five minutes before the scheduled appointment. This will allow you time to follow the link, arrive in the waiting room, and prepare to meet with the provider.\",\n        \"_items_7_answer\": \"field_faq_items_answer\",\n        \"items_8_question\": \"Where is the best place for me to join the Virtual Health Visit appointment? \",\n        \"_items_8_question\": \"field_faq_items_question\",\n        \"items_8_answer\": \"You can join from the comfort of your home or from another private and quiet area where you will not be disturbed.\\r\\n\\r\\nPlease do not join your appointment while driving or from a place where it\u2019s difficult to hear.\\r\\n\\r\\nPlease make sure your device is well charged or connected to a power source before your visit.\",\n        \"_items_8_answer\": \"field_faq_items_answer\",\n        \"items_9_question\": \"Why does the provider appear to look away from the screen sometimes?  \",\n        \"_items_9_question\": \"field_faq_items_question\",\n        \"items_9_answer\": \"The provider is fully focused on you during the visit and is not distracted. 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                    "post_title": "FREQUENTLY ASKED QUESTIONS: <br>The Virtual Health Visit",
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                    "ID": 3464,
                    "post_author": "3",
                    "post_date": "2020-09-05 22:05:17",
                    "post_date_gmt": "2020-09-05 22:05:17",
                    "post_content": "<!-- wp:acf\/hero {\n    \"id\": \"block_5f189b8757435\",\n    \"name\": \"acf\\\/hero\",\n    \"data\": {\n        \"background_image_image\": \"\",\n        \"_background_image_image\": \"field_hero_background_image_image\",\n        \"background_image_caption\": \"\",\n        \"_background_image_caption\": \"field_hero_background_image_caption\",\n        \"background_image\": \"\",\n        \"_background_image\": \"field_hero_background_image\",\n        \"heading\": \"Grievances and Appeals\",\n        \"_heading\": \"field_hero_heading\",\n        \"subheading\": \"Check below to find about the grievances and appeals process for your plan\",\n        \"_subheading\": \"field_hero_subheading\",\n        \"text\": \"\",\n        \"_text\": \"field_hero_text\",\n        \"button\": \"\",\n        \"_button\": \"field_hero_button\"\n    },\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:acf\/plan-set {\n    \"id\": \"block_5f187c5691cbf\",\n    \"name\": \"acf\\\/plan-set\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_plan-set_heading\",\n        \"subheading\": \"\",\n        \"_subheading\": \"field_plan-set_subheading\",\n        \"bottom_plan_active\": \"0\",\n        \"_bottom_plan_active\": \"field_plan-set_bottom_plan_active\",\n        \"cards_0_heading\": \"VNSNY CHOICE Total (HMO D-SNP)\",\n        \"_cards_0_heading\": \"field_plan-set_cards_heading\",\n        \"cards_0_description\": \"\",\n        \"_cards_0_description\": \"field_plan-set_cards_description\",\n        \"cards_0_button\": {\n            \"title\": \"Learn about Total Grievances and Appeals\",\n            \"url\": \"https:\\\/\\\/www.vnsnychoice.org\\\/total-grievance-and-appeals\\\/\",\n            \"target\": \"\"\n        },\n        \"_cards_0_button\": \"field_plan-set_cards_button\",\n        \"cards_0_disable_exit_notifier\": \"0\",\n        \"_cards_0_disable_exit_notifier\": \"field_plan-set_cards_disable_exit_notifier\",\n        \"cards_0_rich_text\": \"\",\n        \"_cards_0_rich_text\": \"field_plan-set_cards_rich_text\",\n        \"cards_1_heading\": \"VNSNY CHOICE MLTC\",\n        \"_cards_1_heading\": \"field_plan-set_cards_heading\",\n        \"cards_1_description\": \"\",\n        \"_cards_1_description\": \"field_plan-set_cards_description\",\n        \"cards_1_button\": {\n            \"title\": \"Learn about MLTC Grievances and Appeals\",\n            \"url\": \"https:\\\/\\\/www.vnsnychoice.org\\\/vnsny-choice-mltc-grievances-and-appeals\\\/\",\n            \"target\": \"\"\n        },\n        \"_cards_1_button\": \"field_plan-set_cards_button\",\n        \"cards_1_disable_exit_notifier\": \"0\",\n        \"_cards_1_disable_exit_notifier\": \"field_plan-set_cards_disable_exit_notifier\",\n        \"cards_1_rich_text\": \"\",\n        \"_cards_1_rich_text\": \"field_plan-set_cards_rich_text\",\n        \"cards\": 2,\n        \"_cards\": \"field_plan-set_cards\",\n        \"button\": \"\",\n        \"_button\": \"field_plan-set_button\"\n    },\n    \"mode\": \"edit\"\n} \/-->",
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                    "post_date": "2020-07-30 19:43:19",
                    "post_date_gmt": "2020-07-30 19:43:19",
                    "post_content": "<!-- wp:paragraph -->\n<p>Thank you for being part of the VNSNY CHOICE Provider Network. We appreciate all that you do for our members!<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Have questions?&nbsp; We\u2019re here to help! You can find answers to most of your questions on this page or by clicking on the tabs to the left. If there\u2019s something you don\u2019t understand or need more help with, just call Provider Relations. Or fill out our <a href=\"https:\/\/www.vnsnychoice.org\/contact-us\/\">online contact form<\/a>, which can also be found by clicking the blue \u201cCONTACT US\u201d button at the top right side of this page. We will get back to you as soon as we can.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>This is your gateway to the digital tools, policies, guidance, and materials you and your staff need to deliver high-quality service to your patients and clients in VNSNY CHOICE health plans. We hope these resources make your experience as efficient and rewarding as possible.<br><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/faq {\n    \"id\": \"block_5f58eb8219bce\",\n    \"name\": \"acf\\\/faq\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_faq_heading\",\n        \"items_0_question\": \"Provider Manual\",\n        \"_items_0_question\": \"field_faq_items_question\",\n        \"items_0_answer\": \"<p class=\\\"schema-faq-answer\\\">Here in one PDF document, are answers to all your questions about VNSNY CHOICE policies and procedures concerning member care, claims, and authorizations, and everything providers should know about working with us.<\\\/p>\\r\\n\\r\\nYou can view or download the entire <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Manual.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">VNSNY CHOICE Provider Manual (PDF)<\\\/a>.\\r\\n\\r\\nOr you may download individual sections from the VNSNY CHOICE Provider Manual from the list below for quick access to the information you need.\\r\\nIf you're looking for an easy way to find the forms and documents referenced in the Provider Manual, just use this list of <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Manual-Helpful-Links.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Helpful Links for CHOICE providers<\\\/a>.\\r\\n\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Manual-Section-1.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Section 1 - Programs, Benefits, and Covered Services<\\\/a>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Manual-Section-2.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Section 2 - Provider Networks<\\\/a>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Manual-Section-3.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Section 3 - Eligibility and Membership<\\\/a>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Manual-Section-4.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Section 4 - Regulatory and Quality Reporting Requirements<\\\/a>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Manual-Section-5.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Section 5 - Primary Care<\\\/a>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Manual-Section-6.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Section 6 - Delegated Vendor Operations<\\\/a>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Manual-Section-7.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Section 7 - Ancillary and Other Special Services<\\\/a>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Manual-Section-8.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Section 8 - Medical Management<\\\/a>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Manual-Section-9.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Section 9 - Billings and Claims Processing<\\\/a>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Manual-Section-10.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Section 10 - Grievances and Appeals<\\\/a>\",\n        \"_items_0_answer\": \"field_faq_items_answer\",\n        \"items_1_question\": \"Providers Quick Reference Guide\",\n        \"_items_1_question\": \"field_faq_items_question\",\n        \"items_1_answer\": \"<p>The <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/04\\\/VNSNY-CHOICE-Provider-Reference-Guide.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Quick Reference Guide<\\\/a> is a convenient resource when you have questions about the following:<br \\\/>\\r\\n\u2022 Claims<br \\\/>\\r\\n\u2022 Member Services<br \\\/>\\r\\n\u2022 Medical Management<br \\\/>\\r\\n\u2022 Utilization<br \\\/>\\r\\n\u2022 Compliance<br \\\/>\\r\\n\u2022 Pharmacy<br \\\/>\\r\\n\u2022 Participating Labs<\\\/p>\\r\\n<p>SelectHealth providers can also find contact information for troubleshooting provider-related concerns on the <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/05\\\/SelectHealth-Provider-Reference-Guide_May-2021.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">SelectHealth Provider Reference Guide<\\\/a>.<\\\/p>\",\n        \"_items_1_answer\": \"field_faq_items_answer\",\n        \"items_2_question\": \"Helpful Links for VNSNY CHOICE Providers\",\n        \"_items_2_question\": \"field_faq_items_question\",\n        \"items_2_answer\": \"<p>This list of <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/helpful-links-for-vnsny-choice-providers\\\/\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">helpful links for providers<\\\/a> offers an easy way to find and access all of the forms and documents you will need as an in-network provider with VNSNY CHOICE.<\\\/p>\",\n        \"_items_2_answer\": \"field_faq_items_answer\",\n        \"items_3_question\": \"Provider Portal Access\",\n        \"_items_3_question\": \"field_faq_items_question\",\n        \"items_3_answer\": \"<p class=\\\"schema-faq-answer\\\">Check patient eligibility and benefits and manage your claims.<\\\/p>\\r\\n<a class=\\\"noExitNotifier\\\" href=\\\"https:\\\/\\\/vnsproviderportal.tmghealth.com\\\/home\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Not yet registered for portal access? Register now<\\\/a>.\\r\\n\\r\\nThis portal is for VNSNY CHOICE Health Plan providers. Follow the link, if you wish to <a class=\\\"noExitNotifier\\\" href=\\\"https:\\\/\\\/providerlink.hchb.com\\\/\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">access the VNSNY Physician Web Portal<\\\/a>.\",\n        \"_items_3_answer\": \"field_faq_items_answer\",\n        \"items_4_question\": \"Demographic Update Form\",\n        \"_items_4_question\": \"field_faq_items_question\",\n        \"items_4_answer\": \"Participating PCPs and Specialists: Here's a quick and easy way to let us know about <a class=\\\"noExitNotifier\\\" href=\\\"https:\\\/\\\/formstack.io\\\/A7DF7\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">changes to your demographic information<\\\/a>!\",\n        \"_items_4_answer\": \"field_faq_items_answer\",\n        \"items_5_question\": \"HHAeXchange Platform (HHAX)\",\n        \"_items_5_question\": \"field_faq_items_question\",\n        \"items_5_answer\": \"Our partnership with HHAX is designed to streamline the ordering, fulfillment,\u00a0and billing of paraprofessional services for CHOICE providers.\",\n        \"_items_5_answer\": \"field_faq_items_answer\",\n        \"items_6_question\": \"Medication Prior Authorization Request Forms\",\n        \"_items_6_question\": \"field_faq_items_question\",\n        \"items_6_answer\": \"Find <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/for-health-professionals-overview\\\/all-forms\\\/\\\">request forms<\\\/a> for drug coverage exceptions and medications.\",\n        \"_items_6_answer\": \"field_faq_items_answer\",\n        \"items\": 7,\n        \"_items\": \"field_faq_items\"\n    },\n    \"mode\": \"edit\"\n} \/-->",
                    "post_title": "Health Professionals Overview",
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                            "ID": 991,
                            "post_author": "3",
                            "post_date": "2020-07-31 17:00:34",
                            "post_date_gmt": "2020-07-31 17:00:34",
                            "post_content": "<!-- wp:heading {\"level\":3} -->\n<h3><strong>TMG Portal<\/strong> for VNSNY CHOICE Providers<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p><a href=\"https:\/\/vnsproviderportal.tmghealth.com\/home\" target=\"_blank\" rel=\"noreferrer noopener\">Sign in to determine patient eligibility and manage claims. <\/a>&nbsp;<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><a href=\"https:\/\/vnsproviderportal.tmghealth.com\/home\" target=\"_blank\" rel=\"noreferrer noopener\">Not yet registered for portal access? Register now.<\/a><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2020\/08\/VNSNY-CHOICE-Provider-Portal-User-Guide-TMG.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Provider Portal User Guide<\/a><br>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:<br>\u2022 Member Eligibility<br>\u2022 Claim Status<br>\u2022 Set up for EFT<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:html -->\n<div class=\"wp-block-button is-style-outline wp-block-buttons aligncenter\"><a class=\"wp-block-button__link noExitNotifier\" href=\"https:\/\/vnsproviderportal.tmghealth.com\/home\" target=\"_blank\" rel=\"noopener noreferrer\">Go to the CHOICE Provider Portal <\/a><\/div>\n<!-- \/wp:html -->\n\n<!-- wp:paragraph -->\n<p>Follow this link, if you wish to access the <a class=\"noExitNotifier\" rel=\"noreferrer noopener\" href=\"https:\/\/providerlink.hchb.com\/\" target=\"_blank\">VNSNY Physician Web Portal<\/a>.<\/p>\n<!-- \/wp:paragraph -->",
                            "post_title": "Access the Provider Portal",
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                        {
                            "ID": 921,
                            "post_author": "3",
                            "post_date": "2020-07-31 15:05:34",
                            "post_date_gmt": "2020-07-31 15:05:34",
                            "post_content": "<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-your-claims-and-remittances\">YOUR CLAIMS AND REMITTANCES&nbsp;<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>At VNSNY CHOICE we understand that easy filing and timely payment of claims are a high priority for our providers. Although you may submit paper claims by mail, there are many benefits to submitting claims electronically, such as improved accuracy, reliability, convenience, and expedited payments.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Claims must be received within 90 days of the date or services (or the time frame stipulated in your contract). If VNSNY CHOICE is not the member\u2019s primary insurance, please submit the claim within 90 days of the date on the Explanation of Payment from the primary carrier.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>Important Updates:<\/strong>&nbsp;<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>As of March 27, 2020, all Claim Disputes must be submitted through VNSNY CHOICE\u2019s <a class=\"noExitNotifier\" rel=\"noreferrer noopener\" href=\"https:\/\/formstack.io\/49580\" target=\"_blank\">Provider Claim Dispute Form<\/a>. Disputes that are not sent through our&nbsp;<a class=\"noExitNotifier\" rel=\"noreferrer noopener\" href=\"https:\/\/formstack.io\/49580\" target=\"_blank\">Provider Claim Dispute Form<\/a>&nbsp;will not be addressed. If you are unsure whether to submit a Claim Dispute or Claim Appeal, please click \"Should I Submit a Claim Dispute or Claim Appeal?\" below.<\/li><li>As of 2\/22\/2021, Availity is the preferred EDI and Portal vendor for VNSNY CHOICE Health Plans transactions. Please see \"How to Submit Electronic Claims\" below.<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:paragraph -->\n<p><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:table -->\n<figure class=\"wp-block-table\"><table><tbody><tr><td>ELECTRONIC PAYMENT FOR PROVIDERS&nbsp;<\/td><\/tr><tr><td>It\u2019s easy to further expedite your claims payments by signing up for electronic funds transfer (EFT) payments that are direct deposited into your bank account. You don\u2019t have to wait for our checks to arrive in the mail or manually sort, reconcile, and deposit checks. Plus, our ePayment provider, Availity, offers an online application that allows you to search, view, and print human-readable images of your remittances.<br><br>You will need to complete&nbsp;<strong>both<\/strong>&nbsp;of the following two steps in order to begin receiving EFT payments and remittances:<br><br>1. To set up EFT payments, visit our <a class=\"noExitNotifier\" rel=\"noreferrer noopener\" href=\"https:\/\/vnsproviderportal.tmghealth.com\/\" target=\"_blank\">provider portal<\/a> and fill out&nbsp;the VNSNY CHOICE EFT Request Form. You will find the request form by clicking on the Provider Education tab at the top of the page.<br><br>2. <span style=\"font-family: inherit; font-size: inherit; font-weight: inherit;\">To receive ERA files,&nbsp;<\/span><a class=\"noExitNotifier\" href=\"https:\/\/www.availity.com\/provider-portal-registration\" target=\"_blank\" rel=\"noreferrer noopener\"><span style=\"text-decoration: underline;\">enroll with Availity directly<\/span><\/a>. <br><br>For more information, please contact a Provider Services Representative at 1-866-783-0222 or&nbsp;<a class=\"noExitNotifier\" rel=\"noreferrer noopener\" href=\"https:\/\/forms.office.com\/Pages\/ResponsePage.aspx?id=AL-L0-142E2gZbphh3tPUAtgMCupwShCiX0iWyzubARUMTBQSVJWV0JPNEVBUUwxV0dQR1pKQ0dVWS4u\" target=\"_blank\"><span style=\"text-decoration: underline;\">e-mail us<\/span><\/a>.&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n<!-- \/wp:table -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-claims-resources\">Claims Resources<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>Consult these additional resources for answers to your questions about claim forms, remittances, billing codes, and the transition from ICD-9 codes to ICD-10 codes.<br><br>If you have any questions or require further assistance, please fill out our&nbsp;<a href=\"https:\/\/www.vnsnychoice.org\/contact-us\/\">Contact Us form<\/a>&nbsp;or call Provider Services at 1-866-783-0222, Monday \u2013 Friday, 8 am \u2010 5 pm.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/faq {\n    \"id\": \"block_5f595656aa978\",\n    \"name\": \"acf\\\/faq\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_faq_heading\",\n        \"items_0_question\": \"How to Submit an Electronic Claim \",\n        \"_items_0_question\": \"field_faq_items_question\",\n        \"items_0_answer\": \"<p>As of 2\\\/22\\\/2021, Availity is the preferred EDI and Portal vendor for VNSNY CHOICE Health Plans transactions. Availity is committed to working with providers and their vendors to ensure there is no disruption in the transmission of your VNSNY CHOICE transactions. For this reason, we\u2019d like to share important information regarding your electronic claim submission, eligibility status verification, electronic remittance advice, and claim status verification. The existing Payer IDs \u2013 77073 and VNSNY \u2013 are not changing and will be used moving forward.<\\\/p>\\r\\n<p>If your current clearinghouse or service provider is unable or not willing to submit transactions through Availity\u2019s EDI Gateway, and no other arrangements are made, potential impacts could include:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>Connectivity \u2013 Your clearinghouse may be unable to transmit any EDI transactions to VNSNY CHOICE after 2\\\/28\\\/2021.<\\\/li>\\r\\n\\t<li>Workflow \u2013 Your clearinghouse may submit your claims via paper, which will delay claim processing, and impact the availability of electronic remittance advice. Other electronic transactions such as eligibility and claim status can also be impacted.<\\\/li>\\r\\n<\\\/ul>\\r\\n<p>VNSNY CHOICE is focused on continuity of service for your EDI transactions.\u00a0 If you are notified of any negative impact to your transactions, please know there are alternate submission options available.<\\\/p>\\r\\n<ul>\\r\\n\\t<li>If you wish to submit directly, you can connect directly to the Availity Gateway at no cost for all VNSNY CHOICE 837, 835, and 27X transactions.<\\\/li>\\r\\n\\t<li>Please visit <a class=\\\"noExitNotifier\\\" href=\\\"https:\\\/\\\/apps.availity.com\\\/web\\\/welcome\\\/#\\\/edi\\\">https:\\\/\\\/apps.availity.com\\\/web\\\/welcome\\\/#\\\/edi<\\\/a> and <a class=\\\"noExitNotifier\\\" href=\\\"http:\\\/\\\/www.availity.com\\\/vns\\\">availity.com\\\/vns<\\\/a> to help set up your business or vendor for submitting EDI transactions through Availity.<\\\/li>\\r\\n\\t<li>Availity\u2019s Provider Engagement Portal is accessible for the following transactions as well; eligibility and benefits inquiry, claim submission, claim status inquiry, and electronic remittance advice. Please ensure you are registered with Availity for this access. (<a class=\\\"noExitNotifier\\\" href=\\\"https:\\\/\\\/www.availity.com\\\/provider-portal-registration\\\">https:\\\/\\\/www.availity.com\\\/provider-portal-registration<\\\/a>).<\\\/li>\\r\\n<\\\/ul>\\r\\n<p><strong>It may take time to work with a clearinghouse or service provider, so please act now to help ensure the continuity of your EDI transactions.<\\\/strong><\\\/p>\\r\\n<p>If you have additional questions or need assistance, please contact Availity Client Services at <a href=\\\"tel:1-800-282-4548\\\">1-800-Availity<\\\/a> (<a href=\\\"tel:1-800-282-4548\\\">1-800-282-4548)<\\\/a>, Monday - Friday, 8 am \u2013 8 pm, Eastern Time.<\\\/p>\",\n        \"_items_0_answer\": \"field_faq_items_answer\",\n        \"items_1_question\": \"How to Submit a Hard Copy (Paper) Claim \",\n        \"_items_1_question\": \"field_faq_items_question\",\n        \"items_1_answer\": \"<p><strong><em>For hard copy (paper) submissions:<\\\/em><\\\/strong><br \\\/>\\r\\nVNSNY CHOICE Claims<br \\\/>\\r\\nP.O. Box 4498<br \\\/>\\r\\nScranton, PA 18505<\\\/p>\\r\\n<p>Or call us at:<br \\\/>\\r\\n<strong>1-866-783-0222<br \\\/>\\r\\n(TTY: 711)<br \\\/>\\r\\nMonday \u2013 Friday, 8 am \u2013 5 pm<\\\/strong><\\\/p>\\r\\n<p><strong><em>Covered Part D vaccine claims should be mailed to:<\\\/em><\\\/strong><br \\\/>\\r\\nMedImpact Healthcare Systems<br \\\/>\\r\\nP.O. Box 509108<br \\\/>\\r\\nSan Diego, CA 92150-9108<\\\/p>\\r\\n<p>Check our Required Data for Claims Forms below for sample forms and a list of required data elements, MLTC provider billing instructions for MLTC and nursing home providers, and provider codes for Adult Day Care, Chore Services, and Home Delivered Meals providers.<\\\/p>\",\n        \"_items_1_answer\": \"field_faq_items_answer\",\n        \"items_2_question\": \"How to Check Claim Status?\",\n        \"_items_2_question\": \"field_faq_items_question\",\n        \"items_2_answer\": \"<p>It\u2019s easy to check on the status of a claim you\u2019ve submitted by signing into the\u00a0<a class=\\\"noExitNotifier\\\" href=\\\"https:\\\/\\\/vnsproviderportal.tmghealth.com\\\/portal\\\/home\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Provider Portal<\\\/a>.<\\\/p>\\r\\n<p>For information on how to use the Provider Portal, including how to verify member eligibility, please view this\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Portal-User-Guide-TMG.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Provider Portal User\u2019s Guide (PDF)<\\\/a>.<\\\/p>\",\n        \"_items_2_answer\": \"field_faq_items_answer\",\n        \"items_3_question\": \"Provider Remittance Guide\",\n        \"_items_3_question\": \"field_faq_items_question\",\n        \"items_3_answer\": \"<p>To receive Electronic Remittance Advice (ERA) files, you\u2019ll need to <u><a class=\\\"noExitNotifier\\\" href=\\\"https:\\\/\\\/www.availity.com\\\/provider-portal-registration\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">enroll directly with our EDI clearinghouse Availity<\\\/a><\\\/u>.<\\\/p>\\r\\n<p>Please visit\u00a0<a class=\\\"noExitNotifier\\\" href=\\\"http:\\\/\\\/www.availity.com\\\/vns\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">availity.com\\\/vns<\\\/a>\u00a0for a quick reference guide to exchanging EDI transactions through Availity.<\\\/p>\\r\\n<p>For a line-by-line guide to reading VNSNY CHOICE Remittance Forms, please view our\u00a0<u><a title=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/vnsny-choice-provider-remittance-fact-sheet.pdf\\\" href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/VNSNY-CHOICE-Provider-Remittance-Fact-Sheet.pdf\\\" target=\\\"_blank\\\">Provider Remittance Fact Sheet<\\\/a><\\\/u>.<\\\/p>\",\n        \"_items_3_answer\": \"field_faq_items_answer\",\n        \"items_4_question\": \"Should I Submit a Claim Dispute or Claim Appeal?\",\n        \"_items_4_question\": \"field_faq_items_question\",\n        \"items_4_answer\": \"<p><strong>When to use the Provider Claim Dispute Form:<\\\/strong><\\\/p>\\r\\n<ul>\\r\\n\\t<li>Coding denials<\\\/li>\\r\\n\\t<li>Underpaid\\\/overpaid claims<\\\/li>\\r\\n\\t<li>Invalid procedure code\\\/revenue code\\\/diagnosis code<\\\/li>\\r\\n\\t<li>Incorrect modifier<\\\/li>\\r\\n\\t<li>Denied for authorization and provider has authorization letter<\\\/li>\\r\\n<\\\/ul>\\r\\n<p>You can also consult <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Manual-Section-9.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Section 9\u00a0of our\u00a0Provider Manual<\\\/a>\u00a0to review the list of requirements needed for filing a dispute.<\\\/p>\\r\\n<p><strong>When to submit a Claim Appeal:<\\\/strong><br \\\/>\\r\\nIf your claim is denied and you wish to challenge the decision, you can use the\u00a0<strong>Grievance and Appeal<\\\/strong>\u00a0Process. This will lead to an internal clinical or administrative review of the denial.<\\\/p>\\r\\n<p>Examples of appealable denials include:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>Services not authorized<\\\/li>\\r\\n\\t<li>Not medically necessary<\\\/li>\\r\\n\\t<li>Non-covered service<\\\/li>\\r\\n\\t<li>Non-covered benefit<\\\/li>\\r\\n\\t<li>Benefit exhausted<\\\/li>\\r\\n\\t<li>Charges previously considered<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_4_answer\": \"field_faq_items_answer\",\n        \"items_5_question\": \"How to Submit a Claim Dispute\",\n        \"_items_5_question\": \"field_faq_items_question\",\n        \"items_5_answer\": \"<p class=\\\"schema-faq-answer\\\"><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/Submit-Claims-Instructions.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Please click here for complete instructions for submitting a Provider Claim Dispute.<\\\/a><\\\/p>\\r\\n<ol>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">\u00a0When submitting a disputed claim, you must include an excel attachment. <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/CHOICE-Provider-Payment-Dispute-Template.xls\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Download this template<\\\/a> and use it to enter the information listed in each column. We'll need it in order to process your payment dispute. (Note: if you don't see the template right away, check your browser's download status bar or the download file on your computer.)<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">Attach the file in the field labeled \\\"File upload\\\" when you submit your dispute using this <a class=\\\"noExitNotifier\\\" href=\\\"http:\\\/\\\/formstack.io\\\/49580\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Claim Dispute Form<\\\/a>.<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">Look for an email confirmation of your submission.<\\\/li>\\r\\n<\\\/ol>\\r\\n<p>You can also consult\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Manual-Section-9.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Section 9\u00a0of our\u00a0Provider Manual<\\\/a>\u00a0to review the list of requirements needed to filing a dispute.<\\\/p>\\r\\n<p>&nbsp;<\\\/p>\",\n        \"_items_5_answer\": \"field_faq_items_answer\",\n        \"items_6_question\": \"How to Submit a Claim Appeal\",\n        \"_items_6_question\": \"field_faq_items_question\",\n        \"items_6_answer\": \"<p class=\\\"schema-faq-answer\\\">If you want to file an appeal, the request must be submitted in writing, via fax or mail.<br \\\/>\\r\\nPlease send your request by fax\u00a0to 1-866-791-2213.<\\\/p>\\r\\n<p>Or by mail to:<\\\/p>\\r\\n<p>VNSNY CHOICE Health Plans<br \\\/>\\r\\nAttn: Grievances &amp; Appeals<br \\\/>\\r\\nP.O. Box 445<br \\\/>\\r\\nElmsford, NY 10523<\\\/p>\\r\\n<p>Consult\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Manual-Section-9.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Section 9\u00a0of our\u00a0Provider Manual<\\\/a>\u00a0to review the list of requirements and time frames needed for filing an appeal.<\\\/p>\\r\\n<p>Claim Appeals: Notification of a decision will be made within 60 calendar days of receiving the appeal. If you are an out-of-network provider filing a claim appeal, a decision may take up to 120 days if a completed <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/CHOICE-Waiver-of-Liability-Form.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Waiver of Liability form<\\\/a> is needed. No extension may be taken on payment appeals and payment appeals cannot be processed as \u201cfast\u201d appeals.<\\\/p>\",\n        \"_items_6_answer\": \"field_faq_items_answer\",\n        \"items_7_question\": \"Required Data for Claims Forms\",\n        \"_items_7_question\": \"field_faq_items_question\",\n        \"items_7_answer\": \"<p class=\\\"schema-faq-answer\\\">The\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/CMS-1500_Sample-Provider-Claim.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">CMS-1500 claim form<\\\/a>\u00a0(sample<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/CMS-1500_Sample-Provider-Claim.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">)<\\\/a>\u00a0and\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/UB-04_Sample-Provider-Claim.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">UB-04 claim form<\\\/a>\u00a0(sample) can be used to bill fee-for-service encounters. The UB-04 form should be used by facilities and by facilities billing on behalf of employed providers.<\\\/p>\\r\\n<p>Please be sure your claim has these\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/Required-Data-CHOICE-Provider-Claims.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">required data\u00a0elements<\\\/a>\u00a0before submitting your form. This information is needed for claims to be processed correctly.<\\\/p>\\r\\n<p>You can find instructions for submitting your claim\u00a0by clicking on\u00a0How to Submit Claims, above.<\\\/p>\",\n        \"_items_7_answer\": \"field_faq_items_answer\",\n        \"items_8_question\": \"Claim Submission Instructions for VNSNY CHOICE Providers\",\n        \"_items_8_question\": \"field_faq_items_question\",\n        \"items_8_answer\": \"<div id=\\\"faq-question-1596204710788\\\" class=\\\"schema-faq-section\\\">\\r\\n<p class=\\\"schema-faq-answer\\\">In-network providers should follow these <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/CHOICE-Providers-Billing-Procedures.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">billing procedures<\\\/a> when submitting claims to VNSNY CHOICE.<\\\/p>\\r\\n<\\\/div>\",\n        \"_items_8_answer\": \"field_faq_items_answer\",\n        \"items_9_question\": \"ICD-10 FAQs\",\n        \"_items_9_question\": \"field_faq_items_question\",\n        \"items_9_answer\": \"<p>These are the most frequently asked questions about the\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/ICD-10_FAQ-VNSNY-CHOICE.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">transition from ICD<\\\/a><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/ICD-10_FAQ-VNSNY-CHOICE.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">-<\\\/a><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/ICD-10_FAQ-VNSNY-CHOICE.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">9 codes to ICD-10\u00a0codes<\\\/a> and how it affects in-network providers for VNSNY CHOICE.<\\\/p>\",\n        \"_items_9_answer\": \"field_faq_items_answer\",\n        \"items_10_question\": \"I am a physician with a CHOICE Total patient in hospice care. Whom do I bill for my services?\",\n        \"_items_10_question\": \"field_faq_items_question\",\n        \"items_10_answer\": \"<p>If you are a physician who ordinarily provides primary or specialty care services to a patient who is now in hospice, you should bill CHOICE directly. You do not need to bill both CMS and CHOICE, unless you are specifically a hospice provider or facility. For more detailed information, see our <strong><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/hospice-benefit\\\/\\\">Hospice Benefit FAQs<\\\/a><\\\/strong>.<\\\/p>\",\n        \"_items_10_answer\": \"field_faq_items_answer\",\n        \"items_11_question\": \"Billing Instructions for Nursing Home Providers\",\n        \"_items_11_question\": \"field_faq_items_question\",\n        \"items_11_answer\": \"<p class=\\\"schema-faq-answer\\\">Check these\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/Billing-Info-Nursing-Home-Providers_CHOICE.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Billing Instructions for Nursing Home Providers<\\\/a>\u00a0for information about billing and claims procedures.<\\\/p>\",\n        \"_items_11_answer\": \"field_faq_items_answer\",\n        \"items_12_question\": \"Claims Layout Information and Provider Codes\",\n        \"_items_12_question\": \"field_faq_items_question\",\n        \"items_12_answer\": \"<div id=\\\"faq-question-1596204768185\\\" class=\\\"schema-faq-section\\\">Please find provider codes and claims layout information for:<\\\/div>\\r\\n<div id=\\\"faq-question-1596204787186\\\" class=\\\"schema-faq-section\\\">\\r\\n<p class=\\\"schema-faq-answer\\\"><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/CHOICE-Claims-Provider-Codes_Adult-Day.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Adult Day Care Providers<\\\/a><br \\\/>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/CHOICE-Claims-Provider-Codes_Chore-Services.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Chore Service Providers<\\\/a><br \\\/>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/CHOICE-Claims-Provider-Codes_Home-Delivered-Meals.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Home Delivered Meals Providers<\\\/a><\\\/p>\\r\\n<\\\/div>\",\n        \"_items_12_answer\": \"field_faq_items_answer\",\n        \"items\": 13,\n        \"_items\": \"field_faq_items\"\n    },\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-\"><\/h3>\n<!-- \/wp:heading -->",
                            "post_title": "Claims and Payment Information and Resources",
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                            "post_modified": "2021-05-06 14:59:21",
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                            "post_date": "2020-07-31 15:13:39",
                            "post_date_gmt": "2020-07-31 15:13:39",
                            "post_content": "<!-- wp:paragraph -->\n<p>Credentialing is required for all physicians who provide services to VNSNY CHOICE members, as well as all other health professionals and facilities that are permitted to practice independently under state law and provide services to VNSNY CHOICE members, with the exception of hospital-based healthcare professionals.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Our credentialing process is designed to protect members and provide continued assurance that potential and\/or currently participating providers meet the requirements necessary for the provision of quality care and service. The objectives of the VNSNY CHOICE Credentialing Program are to ensure that:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list {\"ordered\":true} -->\n<ol><li>Members who join VNSNY CHOICE will have their care rendered by appropriately qualified providers<\/li><li>Each provider applicant has equal opportunity to participate<\/li><li>Adequate information pertaining to education, training, relevant experience, and other credentialing criteria is reviewed by the appropriate individuals prior to approval or denial by the Credentialing Subcommittee<\/li><\/ol>\n<!-- \/wp:list -->\n\n<!-- wp:paragraph -->\n<p><strong>NOTE<\/strong>: If you are one of the providers listed below, you will need to join our network through one of our delegated vendors. Please check here for information about how to <a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2021\/04\/VNSNY-CHOICE-Delegated-Vendor-Services-Contact-Information.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">contact the appropriate delegated vendor<\/a> directly.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>Behavioral Health Specialist\/OMH or OASAS certified facility\/Substance Abuse provider<\/li><li>Dental provider&nbsp;<\/li><li>Optometrist&nbsp;<\/li><li>Transportation<\/li><li>Pharmacy provider&nbsp;<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:acf\/faq {\n    \"id\": \"block_5f5a48ac393ca\",\n    \"name\": \"acf\\\/faq\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_faq_heading\",\n        \"items_0_question\": \"How to Submit Credentialing Requests (New Practitioners)\",\n        \"_items_0_question\": \"field_faq_items_question\",\n        \"items_0_answer\": \"<div id=\\\"faq-question-1598555101117\\\" class=\\\"schema-faq-section\\\">\\r\\n<p>VNSNY CHOICE participates with\u00a0<a class=\\\"noExitNotifier\\\" href=\\\"https:\\\/\\\/proview.caqh.org\\\/Login\\\/Index?ReturnUrl=%2f\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">CAQH Proview<\\\/a>. Practitioners are required to complete the CAQH Proview credentialing application and make their information available to VNSNY CHOICE for use.<\\\/p>\\r\\n<p><strong>PLEASE NOTE<\\\/strong>: Once your contract is validated a VNSNY representative will provide a direct link to submit your request along with the supplemental documentation.<\\\/p>\\r\\n<p>To be credentialed, you will need to include the following with your request:<\\\/p>\\r\\n<\\\/div>\\r\\n<ul>\\r\\n\\t<li>Board Certification or Board Eligibility Letter<\\\/li>\\r\\n\\t<li>Copy of Curriculum Vitae\\\/Resume, including work history in a month\\\/year format (Gaps of 6 month or more must be accounted for)<\\\/li>\\r\\n\\t<li>Copy of Drug Enforcement Agency and\\\/or Controlled Dangerous Substances (CDS) certificate<\\\/li>\\r\\n\\t<li>Copy of Current Malpractice Insurance face sheet with required minimum limits<\\\/li>\\r\\n\\t<li>Summary of pending or settled malpractice cases\\\/necessary explanations<\\\/li>\\r\\n\\t<li>Current Hospital Affiliation Letter(s), Collaborative Agreement, or Hospital Admitting Arrangement<\\\/li>\\r\\n\\t<li>Current W9<\\\/li>\\r\\n\\t<li>HIV PCP Attestation (if applicable, SelectHealth Contracted Only)<\\\/li>\\r\\n<\\\/ul>\\r\\n<p><strong>What to Expect Next<br \\\/>\\r\\n<\\\/strong>Once your credentialing request has been submitted, you will hear from a Credentialing Specialist within 5 to 10 business days. You will receive one or more of the following:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>\u00a0Signed and returned Provider Agreement<\\\/li>\\r\\n\\t<li>An email informing you of any missing information or additional required credentialing documents needed for approval. If you not supply this information within 10 business days, we will close out your application. You may re-apply after.<\\\/li>\\r\\n\\t<li>After a signed contract is received and your application is under initial review, you will receive an email informing you that your application is in the review process with the VNSNY Credentialing Department and by our Credentialing Subcommittee. It may take up to 60 days from date of this notification for the credentialing process to be completed. The Credentialing Subcommittee meets once during the last week of each month to review applications.<\\\/li>\\r\\n<\\\/ul>\\r\\n<div id=\\\"faq-question-1598555252293\\\" class=\\\"schema-faq-section\\\">\u00a0<\\\/div>\",\n        \"_items_0_answer\": \"field_faq_items_answer\",\n        \"items_1_question\": \"Minimum Criteria Required for Credentialing\\\/Recredentialing of Practitioners\",\n        \"_items_1_question\": \"field_faq_items_question\",\n        \"items_1_answer\": \"<ul>\\r\\n\\t<li>Signed application and agreement<\\\/li>\\r\\n\\t<li>Current unrestricted valid license to practice<\\\/li>\\r\\n\\t<li>Current Federal DEA (if provider type warrants)<\\\/li>\\r\\n\\t<li>Relevant Education and Training<\\\/li>\\r\\n\\t<li>Active enrollment and compliance with Medicaid (if applicable)<\\\/li>\\r\\n\\t<li>Hospital affiliation (if applicable)<\\\/li>\\r\\n\\t<li>Board Certified or Board Eligible<\\\/li>\\r\\n\\t<li>History of Professional Liability claims\\\/settlements\\\/judgements\\\/disciplinary actions<\\\/li>\\r\\n\\t<li>Professional Liability Insurance<\\\/li>\\r\\n\\t<li>Must not be excluded or precluded from participation with Medicaid or Medicare Programs<\\\/li>\\r\\n\\t<li>Must not have opted-out of participation with Medicare<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_1_answer\": \"field_faq_items_answer\",\n        \"items_2_question\": \"Practitioner Rights\",\n        \"_items_2_question\": \"field_faq_items_question\",\n        \"items_2_answer\": \"<em><strong>During the credentialing process, practitioners have the following rights:<\\\/strong><\\\/em>\\r\\n<ul>\\r\\n \\t<li>To review Information obtained in support of their credentialing applications, excluding references, recommendations, or other peer review-protected material<\\\/li>\\r\\n \\t<li>To correct erroneous information, in writing<\\\/li>\\r\\n \\t<li>To be informed of the status of their credentialing\\\/recredentialing application<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_2_answer\": \"field_faq_items_answer\",\n        \"items_3_question\": \"Practitioner Recredentialing\",\n        \"_items_3_question\": \"field_faq_items_question\",\n        \"items_3_answer\": \"<p class=\\\"schema-faq-answer\\\">VNSNY CHOICE requires all practitioners to complete recredentialing every three years. At least 6 months prior to the end of the 3-year credentialing period providers will receive a notice from the Credentialing Department requesting the practitioner to update CAQH Proview and provide any supporting credentialing documentation needed for review and approval.<\\\/p>\\r\\n<p>It is essential all requested documents are submitted in a timely fashion. Failure to do so may result in termination from the provider network. Practitioners who are terminated from the network will need to complete their initial credentialing application and go through the approval process again.<\\\/p>\",\n        \"_items_3_answer\": \"field_faq_items_answer\",\n        \"items_4_question\": \"Facility and Institutional Credentialing & Recredentialing\",\n        \"_items_4_question\": \"field_faq_items_question\",\n        \"items_4_answer\": \"<p>VNSNY CHOICE requires facility providers to complete the\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/04\\\/VNSNY-CHOICE-Facility-Provider-Credentialing-Application.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">credentialing or recredentialing application<\\\/a>. Dependent on the below provider type supplemental documentation is requested and must accompany the application for review and approval.<\\\/p>\\r\\n<p><strong>Which Facilities Require Credentialing?<\\\/strong> The following facility providers require credentialing:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>29-I Facilities (Voluntary Foster Care Agencies)<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">Clinical Laboratories<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">Hospitals<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">Home Health Agencies (LHCSA\\\/CHHA Agencies\\\/FI\\\/CDPAS)<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">Skilled Nursing Facilities<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">Hospices<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">Outpatient Rehabilitation Facilities<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">Ambulatory Surgery Centers<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">Dialysis Centers<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">Outpatient Diabetes Self-Management Training<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">\u00a0Portable X-ray Suppliers<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">\u00a0Diagnostic Treatment Centers (DT&amp;C)<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">\u00a0Federally Qualified Health Center (FQHC)<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">\u00a0Durable Medical Equipment and Medical Supply Vendors (DME)<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">\u00a0Radiology Centers<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">\u00a0Chore &amp; Housekeeping Services<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">\u00a0Environmental Modification Services\\\/CFCO<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">\u00a0Personal Emergency Response System (PERS)<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">\u00a0Social Adult Day Care (SADC)<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">\u00a0Home Delivered Meals<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">\u00a0Transportation (car\\\/livery service, ambulette, ambulance for non-emergency use)<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">Adult Day Health Care (Medical Day Programs)<\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\">Urgent Care Centers<\\\/li>\\r\\n<\\\/ul>\\r\\n<p><strong>Minimum facility qualifications and requirements<\\\/strong> for participating in VNSNY CHOICE networks include, but are not limited to:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>Completed, signed, dated Facility Credentialing Application<\\\/li>\\r\\n\\t<li>Malpractice Insurance Coverage (in accordance to contract)<\\\/li>\\r\\n\\t<li>Current accreditation or acceptable site visit survey (w\\\/ Approved Plan of Corrections, if applicable)<\\\/li>\\r\\n\\t<li>Meets applicable licensing requirements (State Licensure\\\/Operating License\\\/Accreditation Documents)<\\\/li>\\r\\n\\t<li>Current proof of Medicare\\\/Medicaid Participation<\\\/li>\\r\\n\\t<li>Acceptable history with regards to malpractice claims<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_4_answer\": \"field_faq_items_answer\",\n        \"items_5_question\": \"Delegated Credentialing\",\n        \"_items_5_question\": \"field_faq_items_question\",\n        \"items_5_answer\": \"<p>VNSNY CHOICE may choose to delegate provider credentialing and recredentialing to certain organizations that are subject to established policies and protocol. VNSNY CHOICE maintains the responsibility for ensuring that the delegated functions are being performed according to VNSNY CHOICE standards. VNSNY has the right to approve, suspend, or terminate providers.<\\\/p>\\r\\n<p><strong>Delegated Roster Submissions<\\\/strong><\\\/p>\\r\\n<p>Delegated entities are required to submit monthly\\\/quarterly provider rosters through the following link: <a class=\\\"noExitNotifier\\\" href=\\\"https:\\\/\\\/formstack.io\\\/C898A\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">https:\\\/\\\/formstack.io\\\/C898A<\\\/a>.<\\\/p>\\r\\n<p>The\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/05\\\/VNSNY-CHOICE_Delegated_Vendor_Template.xlsx\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Delegated Entities Provider Roster Template<\\\/a>\u00a0consists of:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>Provider Termination\\\/Add\\\/Update<\\\/li>\\r\\n\\t<li>Location Termination\\\/Add<\\\/li>\\r\\n\\t<li>Demographic Updates\\\/Removals<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_5_answer\": \"field_faq_items_answer\",\n        \"items_6_question\": \"Credentialing Forms and Documents\",\n        \"_items_6_question\": \"field_faq_items_question\",\n        \"items_6_answer\": \"<p>These documents will help you with the credentialing process and enable you to adhere to the proper requirements designated and outlined in the\u00a0<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Manual.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Provider Manual<\\\/a>.<\\\/p>\\r\\n<ul>\\r\\n\\t<li class=\\\"schema-faq-answer\\\"><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/05\\\/VNSNY-CHOICE-Disclosure-of-Ownership-and-Conflict-Interest-Statement.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Disclosure of Ownership and Control Interest Statement<\\\/a><\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\"><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/IRS-W-9-Form.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">W-9<\\\/a><\\\/li>\\r\\n\\t<li class=\\\"schema-faq-answer\\\"><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/Provider-Disclosure-Certification-NYDOH.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">NYSDOH Provider Disclosure Form<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/CHOICE-Nurse-Practitioner-Form.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">NYSED NP Collaborative Relationships Attestation Form<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/05\\\/VNSNY-CHOICE-Hospital-Admitting-and-Coverage-Arrangement-Form.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Hospital Admitting Arrangement Form<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/05\\\/VNSNY-CHOICE-Collaborative-Practice-Arrangement-Form.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Collaborative Arrangement Form (Mid-Level Practitioners Only)\u00a0<\\\/a><\\\/li>\\r\\n\\t<li><a class=\\\"noExitNotifier\\\" href=\\\"https:\\\/\\\/formstack.io\\\/63045\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">HIV PCP Annual Attestation for SelectHealth Providers<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/American-Disabilities-Act-ADA-Attestation.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">American Disabilities Act (ADA) Attestation<\\\/a><\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_6_answer\": \"field_faq_items_answer\",\n        \"items\": 7,\n        \"_items\": \"field_faq_items\"\n    },\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:paragraph -->\n<p><\/p>\n<!-- \/wp:paragraph -->",
                            "post_title": "Credentialing Criteria and Resources",
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                            "post_modified": "2021-05-13 11:55:06",
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                            "guid": "https:\/\/www.vnsnychoice.org\/?page_id=970",
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                        {
                            "ID": 974,
                            "post_author": "3",
                            "post_date": "2020-07-31 16:18:55",
                            "post_date_gmt": "2020-07-31 16:18:55",
                            "post_content": "<!-- wp:paragraph -->\n<p>Here you can find forms to join our network, update your demographic information, get prior authorizations for a patient\u2019s medications, and more. <a href=\"https:\/\/www.vnsnychoice.org\/for-health-professionals-overview\/credentialing\/\">You can find credentialing forms by clicking on this link<\/a>.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/resources {\n    \"id\": \"block_5f24434084ee8\",\n    \"name\": \"acf\\\/resources\",\n    \"data\": {\n        \"resource_groups_0_heading\": \"Required for All Current Providers \",\n        \"_resource_groups_0_heading\": \"field_resources_resource_groups_heading\",\n        \"resource_groups_0_resources_0_is_external_resource\": \"0\",\n        \"_resource_groups_0_resources_0_is_external_resource\": \"field_resources_resource_groups_resources_is_external_resource\",\n        \"resource_groups_0_resources_0_heading\": \"Provider Disclosure Certification\",\n        \"_resource_groups_0_resources_0_heading\": \"field_resources_resource_groups_resources_heading\",\n        \"resource_groups_0_resources_0_description\": \"<p>You are required to fill out and return this Provider Disclosure Certification form to VNSNY CHOICE. Please return it by December 31, 2021.<\\\/p>\\r\\n\\r\\n<p>You can scan the completed document and email it as an attachment to: <a href=\\\"mailto:CHOICEcompliancecertification@vnsny.org.\\\" target=\\\"_top\\\">CHOICEcompliancecertification@vnsny.org<\\\/a>.\\r\\n<\\\/p>\\r\\n<p> Or you can print it out and mail it to:\\r\\n<br>VNSNY CHOICE Health Plans\\r\\n<br>220 East 42nd Street, Third Floor\\r\\n<br>New York, NY 10017\\r\\n<br>ATTN: Provider Operations<\\\/p>\",\n        \"_resource_groups_0_resources_0_description\": \"field_resources_resource_groups_resources_description\",\n        \"resource_groups_0_resources_0_files_0_file\": 297,\n        \"_resource_groups_0_resources_0_files_0_file\": \"field_resources_resource_groups_resources_files_file\",\n        \"resource_groups_0_resources_0_files_0_label\": \"NYDOH Provider Disclosure Certification\",\n        \"_resource_groups_0_resources_0_files_0_label\": \"field_resources_resource_groups_resources_files_label\",\n        \"resource_groups_0_resources_0_files\": 1,\n        \"_resource_groups_0_resources_0_files\": \"field_resources_resource_groups_resources_files\",\n        \"resource_groups_0_resources\": 1,\n        \"_resource_groups_0_resources\": \"field_resources_resource_groups_resources\",\n        \"resource_groups_1_heading\": \"Forms for New Providers \",\n        \"_resource_groups_1_heading\": \"field_resources_resource_groups_heading\",\n        \"resource_groups_1_resources_0_is_external_resource\": \"1\",\n        \"_resource_groups_1_resources_0_is_external_resource\": \"field_resources_resource_groups_resources_is_external_resource\",\n        \"resource_groups_1_resources_0_external_resource\": {\n            \"title\": \"Join now\",\n            \"url\": \"https:\\\/\\\/formstack.io\\\/871A6\",\n            \"target\": \"_blank\"\n        },\n        \"_resource_groups_1_resources_0_external_resource\": \"field_resources_resource_groups_resources_external_resource\",\n        \"resource_groups_1_resources_0_disable_exit_notifier\": \"0\",\n        \"_resource_groups_1_resources_0_disable_exit_notifier\": \"field_resources_resource_groups_resources_disable_exit_notifier\",\n        \"resource_groups_1_resources_0_heading\": \"Join The VNSNY CHOICE Network\",\n        \"_resource_groups_1_resources_0_heading\": \"field_resources_resource_groups_resources_heading\",\n        \"resource_groups_1_resources_0_description\": \"Thank you for your interest in joining our CHOICE Provider Network. 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                            "post_title": "Forms for Providers and Patients",
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                            "post_modified": "2021-04-09 14:10:31",
                            "post_modified_gmt": "2021-04-09 18:10:31",
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                            "post_parent": 916,
                            "guid": "https:\/\/www.vnsnychoice.org\/?page_id=974",
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                        {
                            "ID": 983,
                            "post_author": "3",
                            "post_date": "2020-07-31 16:39:49",
                            "post_date_gmt": "2020-07-31 16:39:49",
                            "post_content": "<!-- wp:paragraph -->\n<p>Use the tools below to find network providers and pharmacies in each of our health plans.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:html -->\n<div class=\"wp-block-button is-style-outline wp-block-buttons\"><a class=\"wp-block-button__link noExitNotifier\" href=\"https:\/\/providersearch.vnsnychoice.org\/#\/?plan=map\" target=\"_blank\" rel=\"noopener noreferrer\">VNSNY CHOICE Total (HMO D-SNP) Provider &amp; Pharmacy Search <\/a><\/div>\n<!-- \/wp:html -->\n\n<!-- wp:html -->\n<div class=\"wp-block-button is-style-outline wp-block-buttons\"><a class=\"wp-block-button__link noExitNotifier\" href=\"https:\/\/providersearch.vnsnychoice.org\/#\/?plan=mltc\" target=\"_blank\" rel=\"noopener noreferrer\">VNSNY CHOICE MLTC Provider Search<\/a><\/div>\n<!-- \/wp:html -->\n\n<!-- wp:html -->\n<div class=\"wp-block-button is-style-outline wp-block-buttons\"><a class=\"wp-block-button__link noExitNotifier\" href=\"https:\/\/providersearch.vnsnychoice.org\/#\/?plan=sh\" target=\"_blank\" rel=\"noopener noreferrer\">SelectHealth Provider &amp; Pharmacy Search<\/a><\/div>\n<!-- \/wp:html -->\n\n<!-- wp:paragraph -->\n<p><strong><strong>Questions about Ancillary Services?<\/strong><\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>If you are a VNSNY CHOICE provider and have questions pertaining to one of our third-party providers, please use the contact information listed below.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:table -->\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Audiology<\/strong><\/td><td>Hear USA<br>Vendor Provider Service Line: <a href=\"tel:1-800-333-3389\">1-800-333-3389<\/a>, Option 2<br><a rel=\"noreferrer noopener\" href=\"https:\/\/hearusa.net\/portal\/Account\/LogIn?ReturnUrl=%2fportal%2fDashboard\" target=\"_blank\">https:\/\/hearusa.net\/portal\/Account\/LogIn?ReturnUrl=%2fportal%2fDashboard<\/a><\/td><\/tr><tr><td><strong>Behavioral Health<\/strong><\/td><td>Beacon Health Options (formerly Value Options)<br>Vendor Provider Service Line: <a href=\"tel:1-800-397-1630\">1-800-397-1630<\/a><br><a rel=\"noreferrer noopener\" href=\"https:\/\/www.valueoptions.com\/pc\/eProvider\/providerLogin.do\" target=\"_blank\">https:\/\/www.valueoptions.com\/pc\/eProvider\/providerLogin.do<\/a><\/td><\/tr><tr><td><strong>Dental<\/strong><\/td><td>Healthplex<br>Vendor Provider Service Line: <a href=\"tel: 1-888-468-2183\">1-888-468-2183<br><\/a><a rel=\"noreferrer noopener\" href=\"https:\/\/www.healthplex.com\/provider\" target=\"_blank\">https:\/\/www.healthplex.com\/provider<\/a><\/td><\/tr><tr><td><strong>Pharmacy<\/strong><\/td><td>MedImpact<br>Vendor Provider Service Line: <a href=\"tel:1-800-788-2949\">1-800-788-2949<\/a><br><a rel=\"noreferrer noopener\" href=\"https:\/\/mp.medimpact.com\/physicianportal\/public\/Login.jsp\" target=\"_blank\">https:\/\/mp.medimpact.com\/physicianportal\/public\/Login.jsp<\/a><\/td><\/tr><tr><td><strong>Vision<\/strong><\/td><td>Superior Vision<br>Vendor Provider Service Line: <a href=\"tel:1-877-235-5317\">1-877-235-5317<\/a><br><a href=\"https:\/\/superiorvision.com\/eye-care-professionals\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/superiorvision.com\/eye-care-professionals<\/a><\/td><\/tr><\/tbody><\/table><\/figure>\n<!-- \/wp:table -->\n\n<!-- wp:paragraph -->\n<p><br><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><br><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><br><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><\/p>\n<!-- \/wp:paragraph -->",
                            "post_title": "Provider and Pharmacy Online Search",
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                            "post_name": "search-for-in-network-providers",
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                            "post_modified": "2020-09-28 23:49:10",
                            "post_modified_gmt": "2020-09-28 23:49:10",
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                            "guid": "https:\/\/www.vnsnychoice.org\/?page_id=983",
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                        {
                            "ID": 2059,
                            "post_author": "6",
                            "post_date": "2020-08-27 19:59:37",
                            "post_date_gmt": "2020-08-27 19:59:37",
                            "post_content": "<!-- wp:paragraph -->\n<p>In the rapidly transforming world of healthcare, VNSNY CHOICE understands 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.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-guideline-and-policy-updates\">Guideline and Policy Updates <\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-for-vnsny-choice-total-hmo-d-snp-providers\">For VNSNY CHOICE Total (HMO D-SNP) Providers<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:acf\/faq {\n    \"id\": \"block_5f60dc156d3a9\",\n    \"name\": \"acf\\\/faq\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_faq_heading\",\n        \"items_0_question\": \"New for 2021: Real-time Alerts for PCPs with Member Inpatient Admission or Discharge Information\",\n        \"_items_0_question\": \"field_faq_items_question\",\n        \"items_0_answer\": \"As part of a continued effort to alert VNSNY CHOICE Total (HMO D-SNP) primary care physicians (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.\\r\\n\\r\\nMember PCPs should expect to receive this alert each time a member is admitted and discharged from an inpatient facility via secure email or secure e-fax.\\r\\n\\r\\n<strong>CHOICE requests that providers review the information upon receipt and enter all pertinent information <\\\/strong><strong>into the patient\u2019s medical record<\\\/strong>. Within the alert providers will find the following:\\r\\n<ul>\\r\\n \\t<li>Member demographic information<\\\/li>\\r\\n \\t<li>Admitting provider, diagnosis, and date<\\\/li>\\r\\n \\t<li>Discharge diagnosis, date, and length of stay (if applicable)<\\\/li>\\r\\n<\\\/ul>\\r\\nOther transitions of care best practices include:\\r\\n<ul>\\r\\n \\t<li>Schedule follow-up visits within 14 days of discharge (in office, in home, or telehealth)<\\\/li>\\r\\n \\t<li>Conduct a medication reconciliation during a visit within 14 days of discharge, educating the patient or primary caregiver on any changes\\r\\n<ul>\\r\\n \\t<li><strong>Tip<\\\/strong>: code medication reconciliation in your EMR to close quality gaps electronically:\\r\\n<ul>\\r\\n \\t<li>TCM visit codes meet the Medication Reconciliation measure and close gaps\\r\\n<ul>\\r\\n \\t<li>CPT code 99496 or 99495 for visits within 7 or 14 days, respectively<\\\/li>\\r\\n<\\\/ul>\\r\\n<\\\/li>\\r\\n \\t<li>CPT II <strong>\u00ae <\\\/strong>code 1111F meets the measure for visits between 1-30 days of discharge<\\\/li>\\r\\n<\\\/ul>\\r\\n<\\\/li>\\r\\n \\t<li>Review any potential requirements for tests and treatments, and follow up as needed<\\\/li>\\r\\n \\t<li>Coordinate with the VNSNY CHOICE Care Manager for assistance with referrals for in-network specialists and other services<\\\/li>\\r\\n<\\\/ul>\\r\\n<\\\/li>\\r\\n<\\\/ul>\\r\\nThese alerts are aimed at assisting providers in meeting the HEDIS\u00ae Transition of Care (TRC) measure, among others. Two TRC measure components include:\\r\\n<ul>\\r\\n \\t<li><strong>Documentation in the medical record<\\\/strong> that <strong>inpatient admission notification<\\\/strong> was received on the day of admission or the two following days (3 days total).<\\\/li>\\r\\n \\t<li><strong>Documentation in the medical record<\\\/strong> that <strong>discharge information was received<\\\/strong> on the day of discharge or the two following days (3 days total).<\\\/li>\\r\\n<\\\/ul>\\r\\nThank you for your dedication to CHOICE members and their health.\\r\\n\\r\\nIf you have any questions, or if you would like transitions of care workflow training for your office staff, please contact the VNSNY CHOICE Quality Management Team at: <a href=\\\"mailto:QualityManagement@vnsny.org\\\">QualityManagement@vnsny.org<\\\/a>.\",\n        \"_items_0_answer\": \"field_faq_items_answer\",\n        \"items_1_question\": \"Hospice Benefit Update \",\n        \"_items_1_question\": \"field_faq_items_question\",\n        \"items_1_answer\": \"<p>VNSNY CHOICE Total (HMO D-SNP) is pleased to announce its designation as a CMS Innovation Center Model participant for the Hospice Benefit Program beginning January 1, 2021. Learn more on our <span style=\\\"text-decoration: underline;\\\"><strong><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/hospice-benefit\\\/\\\">Hospice Benefit FAQ page<\\\/a><\\\/strong><\\\/span>.<\\\/p>\",\n        \"_items_1_answer\": \"field_faq_items_answer\",\n        \"items_2_question\": \"Telehealth Guideline Updates \",\n        \"_items_2_question\": \"field_faq_items_question\",\n        \"items_2_answer\": \"<strong><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/CHOICE-Quality-HEDIS-Telehealth-Updates.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">New Guidelines for Telehealth Interventions in four HEDIS Quality Measures<\\\/a><\\\/strong>\\r\\n(For VNSNY CHOICE Total Providers Only)\",\n        \"_items_2_answer\": \"field_faq_items_answer\",\n        \"items_3_question\": \"Opioid Safety Edits Reminder \",\n        \"_items_3_question\": \"field_faq_items_question\",\n        \"items_3_answer\": \"On January 1, 2019 an important change was implemented that may continue to affect your patients. In order to prevent prescription drug abuse and improve the safety of prescription medications, CMS (Centers for Medicare and Medicaid Services), requires all Part D plans to follow opioid safety edits and a Drug Management Program. Recently, VNSNY CHOICE sent a <a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CHOICE-Opioid-Safety-Prescriber-Letter.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">letter to all in-network CHOICE Total prescribers<\\\/a> to help keep you informed about what you need to know. You can also find more information about these requirements on our <a href=\\\"\\\/opioid-safety-edits\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Opioid Safety Edits<\\\/a> page.\",\n        \"_items_3_answer\": \"field_faq_items_answer\",\n        \"items\": 4,\n        \"_items\": \"field_faq_items\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:spacer {\"height\":20} -->\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<!-- \/wp:spacer -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-for-selecthealth-from-vnsny-choice-providers\">For SelectHealth from VNSNY CHOICE Providers<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:acf\/faq {\n    \"id\": \"block_5f60dcef6d3ac\",\n    \"name\": \"acf\\\/faq\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_faq_heading\",\n        \"items_0_question\": \"PrEP Prescribers Directory\",\n        \"_items_0_question\": \"field_faq_items_question\",\n        \"items_0_answer\": \"<p>Please use this online directory from the AIDS Institute to find providers offering the services listed below: <a href=\\\"https:\\\/\\\/providerdirectory.aidsinstituteny.org\\\/\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">https:\\\/\\\/providerdirectory.aidsinstituteny.org\\\/<\\\/a>.<\\\/p>\\r\\n<ul>\\r\\n\\t<li>HIV<\\\/li>\\r\\n\\t<li>HCV<\\\/li>\\r\\n\\t<li>PrEP<\\\/li>\\r\\n\\t<li>PEP<\\\/li>\\r\\n\\t<li>Buprenorphine<\\\/li>\\r\\n\\t<li>STI Services<\\\/li>\\r\\n\\t<li>Opioid Overdose Prevention Program<\\\/li>\\r\\n<\\\/ul>\\r\\n<p>If you\u2019d like to register to be featured in the directory, visit <a href=\\\"https:\\\/\\\/providerdirectory.aidsinstituteny.org\\\/Register\\\/RegisterCreate\\\" target=\\\"_blank\\\">https:\\\/\\\/providerdirectory.aidsinstituteny.org\\\/Register\\\/RegisterCreate<\\\/a>.<\\\/p>\",\n        \"_items_0_answer\": \"field_faq_items_answer\",\n        \"items_1_question\": \"Diagnosing and Treating Opioid Use Disorder (OUD) During COVID-19\",\n        \"_items_1_question\": \"field_faq_items_question\",\n        \"items_1_answer\": \"Even before the COVID-19 pandemic, less than 20% of Americans with OUD received any specialty treatment, according to a 2016 study. Despite this, we know that pharmacologic treatment for OUD can be delivered effectively in primary care settings to improve patients' survival rates. [SAMHSA 2017; Sordo, et al. 2017; Larochelle, et al.2018].\\r\\n\\r\\nDuring the COVID 19 pandemic, 40 states have seen increases in opioid-related deaths, according to a recent <a href=\\\"https:\\\/\\\/www.ama-assn.org\\\/system\\\/files\\\/2020-12\\\/issue-brief-increases-in-opioid-related-overdose.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\"><strong>American Medical Association report<\\\/strong><\\\/a>. In light of this trend, the New York State Department of Health AIDS Institute recommends that primary care clinicians for patients like those from SelectHealth, the Medicaid special needs plan from VNSNY CHOICE, standardly screen for illicit drug use and non-medical use of prescription drugs (e.g., opioids, benzodiazepines, and stimulants) in <a href=\\\"https:\\\/\\\/www.hivguidelines.org\\\/substance-use\\\/\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\"><strong>all adult patients \u226518 years old<\\\/strong><\\\/a>. The Institute also recommends that all clinical care providers in NYS be informed of treatment options for OUD.\\r\\n\\r\\n<strong>Best Standard of Care for OUD<\\\/strong>\\r\\nThe New York State Quality Assurance Reporting Requirements(NYSQARR) recommends that clinicians initiate medication-assisted therapy (MAT) for OUD within 30 days (or earlier) of a new opioid diagnosis. For details refer to the <strong><a href=\\\"https:\\\/\\\/www.health.ny.gov\\\/health_care\\\/managed_care\\\/qarrfull\\\/qarr_2020\\\/docs\\\/qarr_specifications_manual.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Initiation of Pharmacotherapy Upon New Episode of Opioid Dependence<\\\/a> <\\\/strong>quality measure.\\r\\n\\r\\nEnsure your treatment plans align with opioid diagnosis guidelines: SelectHealth members have access to behavioral health providers and facilities through the Beacon Health Options network.\\r\\n\\r\\nBeacon Health Options\\r\\n<a href=\\\"tel:1-855-735-6098\\\">1-855-735-6098<\\\/a>; 24 hours a day, 7 days a week\\r\\n<strong><a href=\\\"http:\\\/\\\/www.BeaconHealthOptions.com\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">www.BeaconHealthOptions.com<\\\/a><\\\/strong>\\r\\n\\r\\n<strong>Common Opioid Dependence Diagnosis Codes<\\\/strong>\\r\\nFor patients with active opioid dependence or a history of dependence, document opioid dependence status (active vs. remission) and use appropriate diagnosis codes:\\r\\n<ul>\\r\\n \\t<li><strong>Opioid active dependence diagnosis codes: F11.10,F11.90, F11.20<\\\/strong><\\\/li>\\r\\n \\t<li><strong>Opioid remission diagnosis codes: F11.11 or F11.21\\r\\n<\\\/strong>If you have any questions about this communication, please contact <a href=\\\"mailto:Sheila.Spiezio@vnsnsy.org\\\">Sheila.Spiezio@vnsnsy.org<\\\/a>.<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_1_answer\": \"field_faq_items_answer\",\n        \"items_2_question\": \"Genentech Prescriber Billing Codes\",\n        \"_items_2_question\": \"field_faq_items_question\",\n        \"items_2_answer\": \"<ul>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/avastin-bevacizumab-CHOICE-SelectHealth-billing-codes.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Avastin (bevacizumab) Prescriber Billing<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/herceptin-trastuzumab-CHOICE-SelectHealth-billing-codes.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Herceptin (trastuzumab) Prescriber Billing<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/perjeta-pertuzumab-CHOICE-SelectHealth-billing-codes.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Perjeta (pertuzumab) Prescriber Billing<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/xolair-omalizumab-CHOICE-SelectHealth-billing-codes.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Xolair (omalizumab) Prescriber Billing<\\\/a><br data-rich-text-line-break=\\\"true\\\" \\\/>\\r\\n<br data-rich-text-line-break=\\\"true\\\" \\\/>\\r\\n<br \\\/>\\r\\n<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_2_answer\": \"field_faq_items_answer\",\n        \"items_3_question\": \"Pharmacy Vaccine Coverage and Billing Notice \",\n        \"_items_3_question\": \"field_faq_items_question\",\n        \"items_3_answer\": \"<p>Please download the <a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CHOICE-SelectHealth-Pharmacy-Vaccine-Coverage-Billing.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Pharmacy Vaccine Coverage and Billing Notice<\\\/a>, effective 5\\\/1\\\/2019.<\\\/p>\",\n        \"_items_3_answer\": \"field_faq_items_answer\",\n        \"items_4_question\": \"Opioid Safety Edits Update\",\n        \"_items_4_question\": \"field_faq_items_question\",\n        \"items_4_answer\": \"Effective October 1, 2019, opioid analgesics prescribed to members of SelectHealth are subject to certain safety edits. Please read these <a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CHOICE-SelectHealth-Opioid-Coverage-Update.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">SelectHealth Opioid Coverage Updates<\\\/a> for more information.\",\n        \"_items_4_answer\": \"field_faq_items_answer\",\n        \"items_5_question\": \"SelectHealth Expands Service Area\",\n        \"_items_5_question\": \"field_faq_items_question\",\n        \"items_5_answer\": \"<strong><a href=\\\"\\\/news\\\/vnsny-choice-selecthealth-expands-service-area\\\/\\\">SelectHealth from VNSNY CHOICE<\\\/a><\\\/strong>, an HIV Special Needs Plan, is now available for Medicaid-eligible New York State residents living outside of NYC, in Nassau and Westchester Counties.\",\n        \"_items_5_answer\": \"field_faq_items_answer\",\n        \"items\": 6,\n        \"_items\": \"field_faq_items\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:spacer {\"height\":20} -->\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<!-- \/wp:spacer -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-general-news-and-notices\">General News and Notices<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:acf\/faq {\n    \"id\": \"block_5f60de796d3b2\",\n    \"name\": \"acf\\\/faq\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_faq_heading\",\n        \"items_0_question\": \"Alert Your Vendors: New Partner Handling CHOICE Online Transactions \",\n        \"_items_0_question\": \"field_faq_items_question\",\n        \"items_0_answer\": \"<p>This is a reminder that effective February 22, 2021, Availity is the preferred<br \\\/>\\r\\nElectronic Data Interchange (EDI) and Portal vendor for VNSNY CHOICE Health Plans transactions. \u00a0<\\\/p>\\r\\n<p>You can also expedite your payments with EFT. To receive ERA files, enroll with Availity directly.\u00a0<\\\/p>\\r\\n<p>Please download this <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/02\\\/CHOICE-Provider-News_Availity-EFT_eblast.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Provider News Update<\\\/a> for more details.<\\\/p>\",\n        \"_items_0_answer\": \"field_faq_items_answer\",\n        \"items_1_question\": \"Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items\",\n        \"_items_1_question\": \"field_faq_items_question\",\n        \"items_1_answer\": \"<p>Resumption of Prior Authorization Activities 7\\\/7\\\/2020:<\\\/p>\\r\\n<p>Given the importance of medical review activities to CMS\u2019 program integrity efforts, CMS will discontinue exercising enforcement discretion for the Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items\u00a0beginning on August 3, 2020, regardless of the status of the public health emergency.\u00a0For Power Mobility Devices and Pressure Reducing Support Surfaces that require prior authorization as a condition of payment, claims with an initial date of service on or after August 3, 2020 must be associated with an affirmative prior authorization decision to be eligible for payment.<\\\/p>\\r\\n<p>Additionally, prior authorization will be required for certain Lower Limb Prosthetics (L5856, L5857, L5858, L5973, L5980, and L5987), with dates of service on or after December 1, 2020.<\\\/p>\\r\\n<p>Please see more information\u00a0<a href=\\\"https:\\\/\\\/www.cms.gov\\\/files\\\/document\\\/provider-burden-relief-faqs.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">here\u00a0(PDF)<\\\/a>. The Required Prior Authorization list can be found\u00a0<a href=\\\"https:\\\/\\\/www.cms.gov\\\/Research-Statistics-Data-and-Systems\\\/Monitoring-Programs\\\/Medicare-FFS-Compliance-Programs\\\/DMEPOS\\\/Downloads\\\/DMEPOS_PA_Required-Prior-Authorization-List.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">here\u00a0(PDF)<\\\/a>.<\\\/p>\",\n        \"_items_1_answer\": \"field_faq_items_answer\",\n        \"items_2_question\": \"Medicaid Fee for Service (FFS) Mosquito Repellent Coverage\",\n        \"_items_2_question\": \"field_faq_items_question\",\n        \"items_2_answer\": \"<p>NYS FFS Medicaid will provide coverage for mosquito repellent when prescribed to enrollees who intend to travel to or return from a Centers of Disease Control (CDC) recognized area of localized Zika transmission. Read the <a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/DOH-Notice-for-Mosquito-Repellent-Coverage.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Department of Health notice<\\\/a> for more information.<\\\/p>\\r\\n\",\n        \"_items_2_answer\": \"field_faq_items_answer\",\n        \"items_3_question\": \"ICD-10 FAQ\",\n        \"_items_3_question\": \"field_faq_items_question\",\n        \"items_3_answer\": \"<p>The ICD-10 FAQ document is intended to provide a general overview of what can be expected with the transition from ICD-9 to ICD-10 as it impacts VNSNY CHOICE providers. Read the<a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/ICD-10-FAQs-for-CHOICE-Providers.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\"> ICD-10 FAQ document<\\\/a>.<\\\/p>\",\n        \"_items_3_answer\": \"field_faq_items_answer\",\n        \"items_4_question\": \"JNC8: Recommendations: Changes in Diagnosis and Treatment of Hypertension\",\n        \"_items_4_question\": \"field_faq_items_question\",\n        \"items_4_answer\": \"<p>Hypertension is one of the most important preventable contributors to disease and death in the United States, leading to myocardial infarction, stroke, and renal failure when it is not detected early and treated appropriately. The Eighth Joint National Committee (JNC8) recently released evidence-based recommendations on treatment thresholds, goals, and medications in the management of hypertension in adults. Read <a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/JNC-8-for-Web.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">JNC8 Recommendations: Changes in Diagnosis and Treatment of Hypertension<\\\/a>.<\\\/p>\",\n        \"_items_4_answer\": \"field_faq_items_answer\",\n        \"items\": 5,\n        \"_items\": \"field_faq_items\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:spacer {\"height\":20} -->\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<!-- \/wp:spacer -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-provider-newsletters-and-special-updates\">Provider Newsletters and Special Updates<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:acf\/faq {\n    \"id\": \"block_5f60dec36d3b6\",\n    \"name\": \"acf\\\/faq\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_faq_heading\",\n        \"items_0_question\": \"Provider News Special Updates \",\n        \"_items_0_question\": \"field_faq_items_question\",\n        \"items_0_answer\": \"<ul>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/03\\\/VNSNY-CHOICE-Provider-News_CAHPS-Survey-Total-PCPs.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Your VNSNY CHOICE Total Patients May Be Surveyed About Care You Provide<\\\/a> <br \\\/>\\r\\n(March 2, 2021)<\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/02\\\/CHOICE-Provider-News_Availity-EFT_eblast.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Alert Your Vendors: New Partner Handling CHOICE Online Transactions<\\\/a> (February 25, 2021)<\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/01\\\/SelectHealth-Opioid-Use-Disorder-Notice_1-5-21.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Diagnosing and Treating Opioid Use Disorder (OUD) During COVID-19<\\\/a> (January 5, 2021)<\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/12\\\/CHOICE-Provider-Claims-Dispute-v-Appeal-blast_12.8.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">\u00a0Appeal a Claim or Dispute a Claim?<\\\/a> (December 8, 2020)<\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/12\\\/CHOICE-Provider-Disclosure-Certificate-PDF-Blast_12.1.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Provider Disclosure Certification Form Required By End of Year<\\\/a> (December 1, 2020)<\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/10\\\/CHOICE-Provider-News-Reassure-SelectHealth-Patients-About-Safety-of-In-Office-Visits.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Reassure SelectHealth Patients Needing Screens and Tests This Fall About the Safety of In-Office Visits<\\\/a> (October 1, 2020)<\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/10\\\/CHOICE-Provider-News-Real-Time-Rx-Benefit-Check.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Real-Time Prescription Benefits from CHOICE Partner MedImpact Going Live October 1<\\\/a> (September 28, 2020)<\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/09\\\/CHOICE-Total-Provider-PCP-HEDIS-Telehealth-Update.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">CHOICE Total Provider Update: Using Telehealth for HEDIS Measures<\\\/a> (September 22, 2020)<\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/CHOICE-Provider-LogistiCare-Facilities-eblast.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">An Important Change for Arranging Non-Emergency Medical Transportation for VNSNY CHOICE Members<\\\/a> (August 18, 2020)<\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/SelectHealth-Welcomes-SCOTUS-Ruling-6.16.20.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">SelectHealth Celebrates SCOTUS Ruling on LGBTQ Rights<\\\/a> (June 16, 2020)<\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CHOICE-Total-COVID-19-Telehealth-Guidance.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Use of Telehealth Services During the COVID-19 Public Health Emergency for CHOICE Total Medicare Providers<\\\/a> (May 14, 2o20)<\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CHOICE-Telehealth-Guidance-eblast_corrected.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Use of Telehealth During the COVID-19 State of Emergency<\\\/a> (March 27, 2020)<\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CHOICE-Emergency-Pharmacy-Guidance-eblast.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Emergency Pharmacy Guidance for Prescribers<\\\/a> (March 20, 2020)<\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CMS-Surveys-CHOICE-Total_LHCSA.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Helping Your CHOICE Total Clients with Surveys This Spring: LHCSAs and for PCPs<\\\/a> (March 17, 2020)<\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CHOICE-Provider-Claims-Dispute-vs-Appeal.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Appeal a Claim vs. Dispute a Claim<\\\/a> (March 13, 2020)<\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/Novel-Coronavirus-HIV-NYCDOH-NYSDOH.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Novel Coronavirus and People with HIV: a joint statement from the NYC Health Department and the NYS Department of Health<\\\/a> (March 13, 2020)<\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CHOICE-COVID-19-Preparedness.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Preparedness for COVID-19<\\\/a> (March 10, 2020)<\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CHOICE-Opioid-Safety-Edit-Reminder.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Opioid safety edits were implemented January 1, 2019<\\\/a> (January 7, 2020)<\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CHOICE-Provider-Disclosure-Certificate.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">2019 Provider Certifications<\\\/a> (November 7, 2019)<\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/SelectHealth-geo-expansion-provider-news.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">SelectHealth Expands to Westchester and Nassau Counties<\\\/a> (October 27, 2019)<\\\/li>\\r\\n\\t<li><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/SelectHealth-Opioid-Safety-Edit-Changes.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Important Changes to Opioid Safety Edits for SelectHealth Providers<\\\/a> (October 4, 2019)<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_0_answer\": \"field_faq_items_answer\",\n        \"items_1_question\": \"Provider News - April 2021 Issue \",\n        \"_items_1_question\": \"field_faq_items_question\",\n        \"items_1_answer\": \"<p><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/04\\\/VNSNY-CHOICE-Provider-News_Issue-7.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">VNSNY CHOICE Provider News - April 2021<\\\/a><\\\/p>\\r\\n<p>In this issue:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>CHOICE Total Webinar: Avoid Record Requests with Accurate Billing Codes<\\\/li>\\r\\n\\t<li>Total PCPs: Sign Up for Clinical Notifications<\\\/li>\\r\\n\\t<li>Patient Satisfaction Survey Season Continues<\\\/li>\\r\\n\\t<li>Medicaid Managed Care Pharmacy Carve-Out Delayed<\\\/li>\\r\\n\\t<li>A Good Time to Test for STIs<\\\/li>\\r\\n\\t<li>Help End the HIV Epidemic: Register as a PrEP Prescriber<\\\/li>\\r\\n\\t<li>More Multi Language Consumer Fact Sheets from DOH<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_1_answer\": \"field_faq_items_answer\",\n        \"items_2_question\": \"Provider News - February 2021 Issue \",\n        \"_items_2_question\": \"field_faq_items_question\",\n        \"items_2_answer\": \"<p><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/02\\\/VNSNY-CHOICE-Provider-News_Issue-6.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">VNSNY CHOICE Provider News - February 2021<\\\/a><\\\/p>\\r\\n<p>In this issue:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>Availity to Handle CHOICE Online Transactions<\\\/li>\\r\\n\\t<li>Risk Adjustment and Reimbursement Rates<\\\/li>\\r\\n\\t<li>CHOICE Total Adds Hospice Benefit<\\\/li>\\r\\n\\t<li>Total to Notify PCPs of Patient Transitions<\\\/li>\\r\\n\\t<li>Patient Satisfaction Survey Season Has Begun<\\\/li>\\r\\n\\t<li>We May Ask to Review Your Records<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_2_answer\": \"field_faq_items_answer\",\n        \"items_3_question\": \"Provider News - November 2020 Issue\",\n        \"_items_3_question\": \"field_faq_items_question\",\n        \"items_3_answer\": \"<p><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/11\\\/CHOICE-Provider-News-Introducing-CHOICE-SelectHealth-Sites.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">VNSNY CHOICE Provider News - November 2020<\\\/a><\\\/p>\\r\\n<p>In this issue:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>Flu Shots More Important in 2020<\\\/li>\\r\\n\\t<li>Our New, Improved Website!<\\\/li>\\r\\n\\t<li>SelectHealth Website Debuts<\\\/li>\\r\\n\\t<li>CHOICE Total Benefit Addresses Food Insecurity<\\\/li>\\r\\n\\t<li>Using Telehealth for HEDIS Measures<\\\/li>\\r\\n\\t<li>Multilingual Fact Sheets for Diabetes, Hypertension Self-<br \\\/>\\r\\nManagement<\\\/li>\\r\\n\\t<li>Results from Our Reader Survey<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_3_answer\": \"field_faq_items_answer\",\n        \"items_4_question\": \"Provider News - August 2020 Issue\",\n        \"_items_4_question\": \"field_faq_items_question\",\n        \"items_4_answer\": \"<p><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-News-Issue-4.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\" data-rich-text-format-boundary=\\\"true\\\">VNSNY CHOICE Provider News - August 2020<\\\/a><\\\/p>\\r\\n<p>In this issue:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>\u00a0Enjoying Provider News? Take Our Reader Survey<\\\/li>\\r\\n\\t<li>\u00a0We Overhauled Our Provider Manual<\\\/li>\\r\\n\\t<li>\u00a0COVID-19 Information, All in One Place<\\\/li>\\r\\n\\t<li>\u00a0An Easy Way to Report Data<\\\/li>\\r\\n\\t<li>\u00a0We Simplified Communicating About Claims<\\\/li>\\r\\n\\t<li>\u00a0Encourage In-Office Visits When Needed<\\\/li>\\r\\n\\t<li>\u00a0We're Surveying Our Members About Their Car<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_4_answer\": \"field_faq_items_answer\",\n        \"items_5_question\": \"Provider News - January 2020 Issue\",\n        \"_items_5_question\": \"field_faq_items_question\",\n        \"items_5_answer\": \"<p><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/VNSNY-CHOICE-Provider-News-January-2020.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">VNSNY CHOICE Provider News - January 2020<\\\/a><\\\/p>\\r\\n<p>In this issue:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>Easily Inquire About a Claim<\\\/li>\\r\\n\\t<li>\u00a0Move to Electronic Payments<\\\/li>\\r\\n\\t<li>\u00a0Avoid Returned or Delayed Claims<\\\/li>\\r\\n\\t<li>\u00a0Bonus Tip: Include CPT II Codes on Bills<\\\/li>\\r\\n\\t<li>CHOICE Total Member Survey This Spring<\\\/li>\\r\\n\\t<li>\u00a0HEDIS Medical Records Review Coming<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_5_answer\": \"field_faq_items_answer\",\n        \"items_6_question\": \"Provider News - October 2020 Issue\",\n        \"_items_6_question\": \"field_faq_items_question\",\n        \"items_6_answer\": \"<p><a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/VNSNY-CHOICE-Provider-Newsletter-October-2019.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">VNSNY CHOICE Provider News - October 2019<\\\/a><\\\/p>\\r\\n<p>In this issue:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>FIDA Demonstration ends on December 31<\\\/li>\\r\\n\\t<li>Enhanced bonuses for viral suppression and a patient satisfaction survey at SelectHealth<\\\/li>\\r\\n\\t<li>\u00a0VNSNY CHOICE Total 2020 enrollment opens on October 15<\\\/li>\\r\\n\\t<li>\u00a0HHAeXchange could promote client safety in real time<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_6_answer\": \"field_faq_items_answer\",\n        \"items\": 7,\n        \"_items\": \"field_faq_items\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:acf\/resources {\n    \"id\": \"block_5fc7cf16b7966\",\n    \"name\": \"acf\\\/resources\",\n    \"data\": {\n        \"resource_groups_0_heading\": \"Required for All Providers \",\n        \"_resource_groups_0_heading\": \"field_resources_resource_groups_heading\",\n        \"resource_groups_0_resources_0_is_external_resource\": \"0\",\n        \"_resource_groups_0_resources_0_is_external_resource\": \"field_resources_resource_groups_resources_is_external_resource\",\n        \"resource_groups_0_resources_0_heading\": \"Provider Disclosure Certification\",\n        \"_resource_groups_0_resources_0_heading\": \"field_resources_resource_groups_resources_heading\",\n        \"resource_groups_0_resources_0_description\": \"<p>You are required to fill out and return this Provider Disclosure Certification form to VNSNY CHOICE. Please return it by December 31, 2020.<\\\/p>\\r\\n\\r\\n<p>You can scan the completed document and email it as an attachment to: <a href=\\\"mailto:CHOICEcompliancecertification@vnsny.org.\\\" target=\\\"_top\\\">CHOICEcompliancecertification@vnsny.org<\\\/a>.\\r\\n<\\\/p>\\r\\n<p> Or you can print it out and mail it to:\\r\\n<br>VNSNY CHOICE Health Plans\\r\\n<br>220 East 42nd Street, Third Floor\\r\\n<br>New York, NY 10017\\r\\n<br>ATTN: Provider Operations<\\\/p>\",\n        \"_resource_groups_0_resources_0_description\": \"field_resources_resource_groups_resources_description\",\n        \"resource_groups_0_resources_0_files_0_file\": 297,\n        \"_resource_groups_0_resources_0_files_0_file\": \"field_resources_resource_groups_resources_files_file\",\n        \"resource_groups_0_resources_0_files_0_label\": \"NYDOH Provider Disclosure Certification\",\n        \"_resource_groups_0_resources_0_files_0_label\": \"field_resources_resource_groups_resources_files_label\",\n        \"resource_groups_0_resources_0_files\": 1,\n        \"_resource_groups_0_resources_0_files\": \"field_resources_resource_groups_resources_files\",\n        \"resource_groups_0_resources\": 1,\n        \"_resource_groups_0_resources\": \"field_resources_resource_groups_resources\",\n        \"resource_groups\": 1,\n        \"_resource_groups\": \"field_resources_resource_groups\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:acf\/content-feed {\n    \"id\": \"block_5f85f5664719c\",\n    \"name\": \"acf\\\/content-feed\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_content-feed_heading\",\n        \"subheading\": \"\",\n        \"_subheading\": \"field_content-feed_subheading\",\n        \"content_type\": \"news\",\n        \"_content_type\": \"field_content-feed_content_type\",\n        \"news_feed_options_feed_type\": \"filtered\",\n        \"_news_feed_options_feed_type\": \"field_content-feed_news_feed_options_feed_type\",\n        \"news_feed_options_selected_filter\": \"91\",\n        \"_news_feed_options_selected_filter\": \"field_content-feed_news_feed_options_selected_filter\",\n        \"news_feed_options\": \"\",\n        \"_news_feed_options\": \"field_content-feed_news_feed_options\",\n        \"button\": \"\",\n        \"_button\": \"field_content-feed_button\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->",
                            "post_title": "Provider News and Updates",
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                            "post_date": "2020-07-31 15:04:36",
                            "post_date_gmt": "2020-07-31 15:04:36",
                            "post_content": "<!-- wp:paragraph -->\n<p>Whether you\u2019re a new provider or a long-standing member of our network, you can find here basic information and tools you need for efficient service of your CHOICE clients and patients.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/faq {\n    \"id\": \"block_5f60d941bb125\",\n    \"name\": \"acf\\\/faq\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_faq_heading\",\n        \"items_0_question\": \"New to Our Network?\",\n        \"_items_0_question\": \"field_faq_items_question\",\n        \"items_0_answer\": \"<p><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CHOICE-provider-welcome-letter.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\"><strong>Welcome From CHOICE Provider Relations<\\\/strong><\\\/a><\\\/p>\\r\\n<p><strong>VNSNY CHOICE Orientation Training (All Health Plans)<\\\/strong> - <strong>COMING SOON<\\\/strong><br \\\/>\\r\\nThis 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.<br \\\/>\\r\\n<br \\\/>\\r\\n<strong><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/about-us\\\/\\\">About Our Plans<\\\/a><\\\/strong> Find out more about our long term care and special needs plans.<\\\/p>\",\n        \"_items_0_answer\": \"field_faq_items_answer\",\n        \"items_1_question\": \"Reference Guides and Fact Sheets\",\n        \"_items_1_question\": \"field_faq_items_question\",\n        \"items_1_answer\": \"<p><strong><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/08\\\/VNSNY-CHOICE-Provider-Portal-User-Guide-TMG.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">The Provider Portal User Guide<\\\/a><\\\/strong><br \\\/>\\r\\nA 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:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>Member Eligibility<\\\/li>\\r\\n\\t<li>Claim Status<\\\/li>\\r\\n\\t<li>Set up for EFT<\\\/li>\\r\\n<\\\/ul>\\r\\n<p><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/04\\\/VNSNY-CHOICE-Provider-Reference-Guide.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\"><strong>Provider Reference Guide<\\\/strong><\\\/a> <strong>(All Plans)<\\\/strong><br \\\/>\\r\\nA convenient resource when you have questions about claims, member services, medical management, utilization, compliance, pharmacy, or participating labs.<\\\/p>\\r\\n<p><strong>Resources for CHOICE Total Providers\u00a0<br \\\/>\\r\\n<br \\\/>\\r\\nHospice Benefit Update <br \\\/>\\r\\n<\\\/strong><\\\/p>\\r\\n<p>VNSNY CHOICE Total (HMO D-SNP) is pleased to announce its designation as a CMS Innovation Center Model participant for the Hospice Benefit Program beginning January 1, 2021. Learn more on our <span style=\\\"text-decoration: underline;\\\"><strong><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/hospice-benefit\\\/\\\">Hospice Benefit FAQ page<\\\/a><\\\/strong><\\\/span>.<\\\/p>\\r\\n<p><strong>Provider Webinar Series\u00a0<\\\/strong><\\\/p>\\r\\n<p><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/04\\\/CHOICE-Total-Webinar_Closing-Care-Gaps-Electronically.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\"><strong>Provider Webinar: Closing the Care Gap Electronically<\\\/strong><\\\/a><\\\/p>\\r\\n<p>VNSNY CHOICE Total (HMO D-SNP) will host a recurring webinar for providers, billers, and office managers on how to close gaps in care electronically to reduce medical record requests.<\\\/p>\\r\\n<p>This webinar is designed to help you understand:<\\\/p>\\r\\n<ul>\\r\\n\\t<li>the role providers play in Medicare Risk Adjustment<\\\/li>\\r\\n\\t<li>how the annual wellness visit can impact payment rates in coming years<\\\/li>\\r\\n\\t<li>how to ensure you\u2019re using the right billing codes to close HEDIS gaps<\\\/li>\\r\\n\\t<li>how to improve workflows to ensure the accuracy of your billing and coding process<\\\/li>\\r\\n<\\\/ul>\\r\\n<div>For more information, read these <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/04\\\/CHOICE-Provider_Risk-Adjustment_Minding-the-Gaps_FAQ.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">FAQs<\\\/a> or contact <a href=\\\"mailto:QualityManagement@vnsny.org\\\">QualityManagement@vnsny.org<\\\/a>.<br \\\/>\\r\\n<br \\\/>\\r\\n<br \\\/>\\r\\n<strong>References for SelectHealth Providers<br \\\/>\\r\\n<\\\/strong><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2021\\\/05\\\/SelectHealth-Provider-Reference-Guide_May-2021.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">SelectHealth Provider Reference Guide<\\\/a> <br \\\/>\\r\\nQuickly find out who to contact for specific plan information.<br \\\/>\\r\\n<br \\\/>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CHOICE-SelectHealth-Advantage-Fact-Sheet.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">SelectHealth Advantage Fact Sheet <\\\/a><br \\\/>\\r\\nLearn more about SelectHealth, including special initiatives and program offerings.<br \\\/>\\r\\n<br \\\/>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/SelectHealth-Drug-Reference-for-Transgender-Care_Eng_10.20.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Treatment of Gender-Dysphoric Persons Quick Reference Guide<\\\/a> <br \\\/>\\r\\nThis guide provides a summary of recommended medication therapies along with their VNSNY CHOICE SelectHealth formulary coverage status.<\\\/div>\\r\\n<div>\\r\\n<p><strong>Beacon Health Provider Reference Tools<\\\/strong> <br \\\/>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/Beacon_Provider_Reference_Tool_IET.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Beacon Health Options Provider Reference Tool - Alcohol and Other Drug Dependence Treatment<\\\/a> <br \\\/>\\r\\nThis provider reference tool offers information about the initiation and engagement of treatment for alcohol and other drug dependence. <br \\\/>\\r\\n<br \\\/>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/Beacon_Provider_Reference_Tool_FUH.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Beacon Health Options Provider Reference Tool - Follow-Up After Mental Illness Hospitalization<\\\/a> <br \\\/>\\r\\nThis provider reference tool offers information about the follow-up process after hospitalization for mental illness.<\\\/p>\\r\\n<p><strong>Special Topics<\\\/strong> <br \\\/>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/VNSNY-CHOICE-Access-and-Availability-Standards.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Access and Availability Standards for Medicare Patients <\\\/a><br \\\/>\\r\\nAccording 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\u2019s 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\u2019s 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<br \\\/>\\r\\n<br \\\/>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/High-Risk-Medications.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">High Risk Medications in the Elderly<\\\/a> <br \\\/>\\r\\nAt VNSNY CHOICE, we know that effective medication management \u2014 especially among the elderly population \u2014 is one of the key strategies for improving quality of patient care and reducing avoidable ED visits and hospitalizations. The Pharmacy Quality Alliance (PQA) has developed a list of High Risk Medications, including their potential risks and safer treatment options.<br \\\/>\\r\\n<br \\\/>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/Pain-Assessment-Body-Mass-Index-Chart.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Pain Assessment, BMI\\\/ Functional Status Chart<\\\/a> <br \\\/>\\r\\nThis 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\u2019s chart to make it easier for you to document the member\u2019s health vitals accurately.<\\\/p>\\r\\n<\\\/div>\",\n        \"_items_1_answer\": \"field_faq_items_answer\",\n        \"items_2_question\": \"Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items\",\n        \"_items_2_question\": \"field_faq_items_question\",\n        \"items_2_answer\": \"<p>Resumption of Prior Authorization Activities 7\\\/7\\\/2020:<\\\/p>\\r\\n<p>Given the importance of medical review activities to CMS\u2019 program integrity efforts, CMS will discontinue exercising enforcement discretion for the Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items\u00a0beginning on August 3, 2020, regardless of the status of the public health emergency.\u00a0For Power Mobility Devices and Pressure Reducing Support Surfaces that require prior authorization as a condition of payment, claims with an initial date of service on or after August 3, 2020 must be associated with an affirmative prior authorization decision to be eligible for payment.<\\\/p>\\r\\n<p>Additionally, prior authorization will be required for certain Lower Limb Prosthetics (L5856, L5857, L5858, L5973, L5980, and L5987), with dates of service on or after December 1, 2020.<\\\/p>\\r\\n<p>Please see more information\u00a0<a href=\\\"https:\\\/\\\/www.cms.gov\\\/files\\\/document\\\/provider-burden-relief-faqs.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">here\u00a0(PDF)<\\\/a>. The Required Prior Authorization list can be found\u00a0<a href=\\\"https:\\\/\\\/www.cms.gov\\\/Research-Statistics-Data-and-Systems\\\/Monitoring-Programs\\\/Medicare-FFS-Compliance-Programs\\\/DMEPOS\\\/Downloads\\\/DMEPOS_PA_Required-Prior-Authorization-List.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">here\u00a0(PDF)<\\\/a>.<\\\/p>\",\n        \"_items_2_answer\": \"field_faq_items_answer\",\n        \"items_3_question\": \"Fact Sheets and Forms for Your Patients\",\n        \"_items_3_question\": \"field_faq_items_question\",\n        \"items_3_answer\": \"<p><strong data-rich-text-format-boundary=\\\"true\\\">Health Information Exchange Facts and Forms<\\\/strong><br \\\/>\\r\\n<br \\\/>\\r\\nInformation in Spanish and English to share with your CHOICE patients explaining how the Health Information Exchange works. Includes an FAQ. (<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/VNSNY-HIE-Fact-Sheet_English.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">English<\\\/a> and <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/VNSNY-HIE-Fact-Sheet_Spanish.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Spanish<\\\/a>)<br \\\/>\\r\\n<br \\\/>\\r\\nAuthorization for Access to Patient\\\/Member Information Through Health Information Exchanges (<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/VNSNY-Auth-for-Patient-Info-HIE_Eng.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">English<\\\/a> and <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/VNSNY-Auth-for-Patient-Info-HIE_Sp.pdf\\\">Spanish<\\\/a>)<br \\\/>\\r\\n<br data-rich-text-line-break=\\\"true\\\" \\\/>\\r\\n<strong><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/Advanced-Directive_Plan.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Advanced Care Planning Form<\\\/a><\\\/strong><br \\\/>\\r\\nHealth 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.<br \\\/>\\r\\nThe 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.<br \\\/>\\r\\nAs 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.<br \\\/>\\r\\n<br \\\/>\\r\\nAdditional forms include the following:<br \\\/>\\r\\nAppointing Your Health Care Proxy (<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/Appointing-Health-Care-Proxy-New-York-State_Eng.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">English<\\\/a> and <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/Appointing-Health-Care-Proxy-New-York-State-Sp.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Spanish<\\\/a>)<br \\\/>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/New-York-Advance-Directive-Planning-Guide.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">New York Advance Directive Planning Guide<\\\/a><br \\\/>\\r\\n<br \\\/>\\r\\n<strong>CHOICE Medications Adherence Tip Sheet<br \\\/>\\r\\n<\\\/strong>VNSNY CHOICE knows the importance of medication adherence. This Medication Adherence tip sheet makes it easy for providers to help CHOICE members take the right meds at the right time \u2014 no matter how complex their medication regimens. In addition, the tip sheet will help empower members and caregivers to easily see what medications to take and when to take them. <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CHOICE-Medication-Adherence-Tip-Sheet.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Read the CHOICE Medications Adherence Tip Sheet<\\\/a>.<br \\\/>\\r\\n<br \\\/>\\r\\n<strong>What Is Medicaid?<br \\\/>\\r\\n<\\\/strong>VNSNY CHOICE offers helpful information about this important government program and <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/how-to-apply-for-medicaid\\\/\\\">How to Apply for Medicaid<\\\/a> that may be useful for both you and your patients or clients.<\\\/p>\",\n        \"_items_3_answer\": \"field_faq_items_answer\",\n        \"items_4_question\": \"Electronic Medical Records \",\n        \"_items_4_question\": \"field_faq_items_question\",\n        \"items_4_answer\": \"<p><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CHOICE-Provider-Supplemental-EMR-Data_Measure-Definitions.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\" data-rich-text-format-boundary=\\\"true\\\">Provider EMR Data-Sharing \u2013 Measure Definitions<br data-rich-text-line-break=\\\"true\\\" \\\/>\\r\\n<\\\/a>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.<br \\\/>\\r\\n<br \\\/>\\r\\n<a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CHOICE-Provider-Supplemental-EMR-Data_Measure-Dictionary.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Provider EMR Data-Sharing \u2013 Measure Dictionary<\\\/a><strong><br \\\/>\\r\\n<\\\/strong>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.<\\\/p>\",\n        \"_items_4_answer\": \"field_faq_items_answer\",\n        \"items_5_question\": \"HIV Treatment Works Campaign\",\n        \"_items_5_question\": \"field_faq_items_question\",\n        \"items_5_answer\": \"<p>Here are some resources that may be helpful to those living with HIV\\\/AIDS, and their families.<br data-rich-text-line-break=\\\"true\\\" \\\/>\\r\\n<br \\\/>\\r\\nVNSNY CHOICE SelectHealth supports the HIV Treatment Works (HTW) Campaign sponsored by the Centers for Disease Control and Prevention (CDC). The HTW campaign features people who are living with HIV talking about how sticking with care and treatment helps them stay healthy, protect other, and live longer, healthier lives.<\\\/p>\\r\\n<ul>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.cdc.gov\\\/stophivtogether\\\/campaigns\\\/hiv-treatment-works\\\/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Factagainstaids%2Fcampaigns%2Fhivtreatmentworks%2Findex.html\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">HIV Treatment Works (HTW) website<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.cdc.gov\\\/stophivtogether\\\/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fstophivtogether%2Fcampaigns%2Fhiv-treatment-works%2Fresources.html\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Watch videos of people living well with HIV<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.cdc.gov\\\/stophivtogether\\\/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fstophivtogether%2Fcampaigns%2Fhiv-treatment-works%2Fresources.html\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Read profiles of people living well with HIV<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.cdc.gov\\\/actagainstaids\\\/campaigns\\\/hivtreatmentworks\\\/resources\\\/index.html\\\">Resources for people living well with HIV<\\\/a><\\\/li>\\r\\n<\\\/ul>\\r\\n<p>HIV Tobacco Cessation Improvement Campaign The New York State Department of Health AIDS Institute is excited to announce the launch of the HIV Tobacco Cessation Improvement Campaign. Antiretroviral therapy is extending the lives of people living with HIV (PLWH); yet, in the US, PLWH who smoke lose over six years of life expectancy compared to PLWH who do not smoke. <br \\\/>\\r\\n<br \\\/>\\r\\nPlease let your patients know about the NYSDOH campaign to help improve the health of PLWH across New York State. Have them visit <a href=\\\"http:\\\/\\\/www.hivtobaccofreeny.org\\\/\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">www.hivtobaccofreeny.org<\\\/a> to enroll and learn more about the campaign. <br \\\/>\\r\\n<br \\\/>\\r\\nNew York State Policies and Guidelines<\\\/p>\\r\\n<ul>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.cdc.gov\\\/stophivtogether\\\/campaigns\\\/hiv-treatment-works\\\/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Factagainstaids%2Fcampaigns%2Fhivtreatmentworks%2Findex.html\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">New York State Department of Health HIV Testing Policies and Procedures<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.hivguidelines.org\\\/\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">New York State Department of Health Updates and Changes to HIV Treatment Guidelines<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.health.ny.gov\\\/diseases\\\/aids\\\/providers\\\/testing\\\/\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">New York State HIV Testing Law - FAQs<\\\/a><\\\/li>\\r\\n<\\\/ul>\\r\\n<p>Additional Resources<\\\/p>\\r\\n<ul>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.health.ny.gov\\\/\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">New York State Department of Health<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www1.nyc.gov\\\/site\\\/doh\\\/index.page\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">New York City Department of Health<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/wp-content\\\/uploads\\\/2020\\\/10\\\/Early-Acute-HIV.pdf\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">Signs and Symptoms of Acute\\\/Early HIV<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/aidsinfo.nih.gov\\\/\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">AIDSInfo (A Service of the U.S. Department of Health and Human Services)<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"http:\\\/\\\/www.aidsinfonet.org\\\/\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">The AIDS InfoNet<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.cdc.gov\\\/hiv\\\/default.html\\\">Ce<\\\/a><a href=\\\"https:\\\/\\\/www.cdc.gov\\\/hiv\\\/default.html\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">nters for Disease Control and Prevention<\\\/a><\\\/li>\\r\\n\\t<li><a href=\\\"https:\\\/\\\/www.womenshealth.gov\\\/hiv-and-aids\\\" target=\\\"_blank\\\" rel=\\\"noreferrer noopener\\\">National Women's Health Information Center<\\\/a><\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_5_answer\": \"field_faq_items_answer\",\n        \"items\": 6,\n        \"_items\": \"field_faq_items\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->",
                            "post_title": "Provider Toolkit",
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                                    "post_date": "2020-07-31 15:10:20",
                                    "post_date_gmt": "2020-07-31 15:10:20",
                                    "post_content": "<!-- wp:heading -->\n<h2>NEW YORK STATE POLICIES&nbsp;<\/h2>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>Please click on the links below to review New York State regulatory changes.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><em>New York State Regulations&nbsp;<\/em><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/VNSNY%20CHOICE_Notice_to_Providers_Concerning_New_York_State_Regulatory_Changes.original.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">New York State Regulatory Updates<\/a>&nbsp;(Effective January 1, 2010)<br><a href=\"http:\/\/www.health.ny.gov\/diseases\/aids\/\" target=\"_blank\" rel=\"noreferrer noopener\">New York State Department of Health HIV Testing Policies and Procedures<\/a><br><a href=\"http:\/\/www.hivguidelines.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">New York State Department of Health Updates and Changes to HIV Treatment Guidelines<\/a><br><a href=\"http:\/\/www.health.ny.gov\/diseases\/aids\/\" target=\"_blank\" rel=\"noreferrer noopener\">New York State HIV Testing Law -<\/a><a href=\"http:\/\/www.health.ny.gov\/diseases\/aids\/\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;Guidance<\/a><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading -->\n<h2>VNSNY CHOICE POLICIES<\/h2>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p><em>VNSNY&nbsp;CHOICE Health Plans Policies and Updates&nbsp;<\/em><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/VNSNY%20CHOICE%20Access%20and%20Availability%20Standards%20%2803.06.17%29.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">VNSNY CHOICE Access and Availability Standards&nbsp;(Medicare and SelectHealth)<\/a><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/CHOICE-Health-Plans-Medicare-Model-of-Care.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">VNSNY CHOICE Medicare Model of Care<\/a><\/li><li><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/Talking_To_Members_About_Advance_Care_Planning_so.original.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Talking to Members About Advance-Care Planning<\/a><\/li><li>VNSNY CHOICE Health Plans Quick Reference Guides for Providers:<ul><li><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/CHOICE_Total_Provider_Guide.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">VNSNY CHOICE Total&nbsp;<\/a><\/li><li><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/CHOICE_MLTC_Provider_Guide_4.3.20.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">VNSNY CHOICE MLTC<\/a><\/li><li><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/SelectHealth-Provider-Reference-Guide_June-2020.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">SelectHealth<\/a><\/li><\/ul><\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:paragraph -->\n<p><\/p>\n<!-- \/wp:paragraph -->",
                                    "post_title": "Policies",
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                                    "post_date": "2020-07-31 15:11:25",
                                    "post_date_gmt": "2020-07-31 15:11:25",
                                    "post_content": "<!-- wp:heading -->\n<h2><strong>VNSNY CHOICE THIRD-PARTY VENDORS&nbsp;<\/strong><\/h2>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>If you are a VNSNY CHOICE provider and have questions pertaining to one of our third-party providers, please use the contact information listed below.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>Audiology<\/strong><br>Hear USA<br>Vendor Provider Service Line: 1-800-333-3389, Option 2<br><a href=\"https:\/\/hearusa.net\/portal\/Account\/LogIn?ReturnUrl=%2fportal%2fDashboard\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/hearusa.net\/portal\/Account\/LogIn?ReturnUrl=%2fportal%2fDashboard<\/a><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>Behavioral Health<\/strong><br>Beacon Health Options (formerly Value Options)<br>VNSNY CHOICE Provider Services: 1-866-783-0222<br>Vendor Provider Service Line: 1-800-397-1630<br><a href=\"https:\/\/www.valueoptions.com\/pc\/eProvider\/providerLogin.do\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.valueoptions.com\/pc\/eProvider\/providerLogin.do<\/a><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>Dental<\/strong><br>Healthplex<br>VNSNY CHOICE Provider Services: 1-866-783-0222<br>Vendor Provider Service Line: 1-888-468-2183<br><a href=\"https:\/\/www.healthplex.com\/provider\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.healthplex.com\/provider<\/a><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>Pharmacy<\/strong><br>MedImpact<br>VNSNY CHOICE Provider Services: 1-866-783-0222<br>Vendor Provider Service Line: 1-800-788-2949<br><a href=\"https:\/\/mp.medimpact.com\/physicianportal\/public\/Login.jsp\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/mp.medimpact.com\/physicianportal\/public\/Login.jsp<\/a><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>Vision<\/strong><br>Superior Vision<br>VNSNY CHOICE Provider Services: 1-866-783-0222<br>Vendor Provider Service Line: 1-866-819-4298<br><a href=\"https:\/\/www.superiorvision.com\/provider\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.superiorvision.com\/provider<\/a><\/p>\n<!-- \/wp:paragraph -->",
                                    "post_title": "Third-Party Vendors",
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                            "ID": 3842,
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                            "post_date": "2020-09-09 22:45:47",
                            "post_date_gmt": "2020-09-09 22:45:47",
                            "post_content": "<!-- wp:paragraph -->\n<p>The VNSNY CHOICE online formulary is a searchable listing that includes thousands of drugs for hundreds of ailments and conditions.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/resources {\n    \"id\": \"block_5f596f70dd485\",\n    \"name\": \"acf\\\/resources\",\n    \"data\": {\n        \"resource_groups_0_heading\": \"Formulary Search\",\n        \"_resource_groups_0_heading\": \"field_resources_resource_groups_heading\",\n        \"resource_groups_0_resources_0_is_external_resource\": \"1\",\n        \"_resource_groups_0_resources_0_is_external_resource\": \"field_resources_resource_groups_resources_is_external_resource\",\n        \"resource_groups_0_resources_0_external_resource\": {\n            \"title\": \"\",\n            \"url\": \"http:\\\/\\\/openenrollment.medimpact.com\\\/#\\\/plancode?vns01202001\",\n            \"target\": \"\"\n        },\n        \"_resource_groups_0_resources_0_external_resource\": \"field_resources_resource_groups_resources_external_resource\",\n        \"resource_groups_0_resources_0_disable_exit_notifier\": \"0\",\n        \"_resource_groups_0_resources_0_disable_exit_notifier\": \"field_resources_resource_groups_resources_disable_exit_notifier\",\n        \"resource_groups_0_resources_0_heading\": \"VNSNY CHOICE Total (HMO D-SNP) Formulary Search \",\n        \"_resource_groups_0_resources_0_heading\": \"field_resources_resource_groups_resources_heading\",\n        \"resource_groups_0_resources_0_description\": \"\",\n        \"_resource_groups_0_resources_0_description\": \"field_resources_resource_groups_resources_description\",\n        \"resource_groups_0_resources_1_is_external_resource\": \"1\",\n        \"_resource_groups_0_resources_1_is_external_resource\": \"field_resources_resource_groups_resources_is_external_resource\",\n        \"resource_groups_0_resources_1_external_resource\": {\n            \"title\": \"\",\n            \"url\": \"http:\\\/\\\/openenrollment.medimpact.com\\\/#\\\/plancode?vns03202001\",\n            \"target\": \"\"\n        },\n        \"_resource_groups_0_resources_1_external_resource\": \"field_resources_resource_groups_resources_external_resource\",\n        \"resource_groups_0_resources_1_disable_exit_notifier\": \"0\",\n        \"_resource_groups_0_resources_1_disable_exit_notifier\": \"field_resources_resource_groups_resources_disable_exit_notifier\",\n        \"resource_groups_0_resources_1_heading\": \"SelectHealth Formulary Search \",\n        \"_resource_groups_0_resources_1_heading\": \"field_resources_resource_groups_resources_heading\",\n        \"resource_groups_0_resources_1_description\": \"\",\n        \"_resource_groups_0_resources_1_description\": \"field_resources_resource_groups_resources_description\",\n        \"resource_groups_0_resources\": 2,\n        \"_resource_groups_0_resources\": \"field_resources_resource_groups_resources\",\n        \"resource_groups_1_heading\": \"Requirements and Policies \",\n        \"_resource_groups_1_heading\": \"field_resources_resource_groups_heading\",\n        \"resource_groups_1_resources_0_is_external_resource\": \"0\",\n        \"_resource_groups_1_resources_0_is_external_resource\": \"field_resources_resource_groups_resources_is_external_resource\",\n        \"resource_groups_1_resources_0_heading\": \"VNSNY CHOICE Total Step Therapy Requirements \",\n        \"_resource_groups_1_resources_0_heading\": \"field_resources_resource_groups_resources_heading\",\n        \"resource_groups_1_resources_0_description\": \"\",\n        \"_resource_groups_1_resources_0_description\": \"field_resources_resource_groups_resources_description\",\n        \"resource_groups_1_resources_0_files_0_file\": 5015,\n        \"_resource_groups_1_resources_0_files_0_file\": \"field_resources_resource_groups_resources_files_file\",\n        \"resource_groups_1_resources_0_files_0_label\": \"<\\\/br>2021 Plan Step Therapy Requirements - 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                            "post_modified": "2021-05-27 21:58:50",
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                            "guid": "https:\/\/www.vnsnychoice.org\/?page_id=3842",
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                    "post_date": "2021-02-05 17:34:23",
                    "post_date_gmt": "2021-02-05 22:34:23",
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                    "post_title": "Helpful Links for VNSNY CHOICE Providers",
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                    "post_content": "<!-- wp:acf\/hero {\n    \"id\": \"block_5f281a914dec5\",\n    \"name\": \"acf\\\/hero\",\n    \"data\": {\n        \"background_image_image\": 1364,\n        \"_background_image_image\": \"field_hero_background_image_image\",\n        \"background_image_caption\": \"\",\n        \"_background_image_caption\": \"field_hero_background_image_caption\",\n        \"background_image\": \"\",\n        \"_background_image\": \"field_hero_background_image\",\n        \"heading\": \"Health plans created to keep you living safely in the comfort of your own home.\",\n        \"_heading\": \"field_hero_heading\",\n        \"subheading\": \"\",\n        \"_subheading\": \"field_hero_subheading\",\n        \"text\": \"\",\n        \"_text\": \"field_hero_text\",\n        \"button\": {\n            \"title\": \"Learn more about our health plans\",\n            \"url\": \"https:\\\/\\\/www.vnsnychoice.org\\\/our-plans\\\/\",\n            \"target\": \"\"\n        },\n        \"_button\": \"field_hero_button\"\n    },\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:acf\/media-text {\n    \"id\": \"block_5f7f876abd336\",\n    \"name\": \"acf\\\/media-text\",\n    \"data\": {\n        \"align_media_right\": \"0\",\n        \"_align_media_right\": \"field_media-text_align_media_right\",\n        \"is_youtube_video\": \"0\",\n        \"_is_youtube_video\": \"field_media-text_is_youtube_video\",\n        \"heading\": \"A Reputation for Quality\",\n        \"_heading\": \"field_media-text_heading\",\n        \"body\": \"<p>VNSNY CHOICE Total (HMO D-SNP) is rated 4 stars by the Centers for Medicare and Medicaid Services and New York State Department of Health.*<\\\/p><p>VNSNY CHOICE MLTC is also rated 4 stars out of 5 by the New York State Department of Health.*<\\\/p>\\r\\n\\r\\n\\r\\n<p><sup>*2019 A Consumer\u2019s Guide to Managed Long-Term Care in New York City.<\\\/sup><\\\/p>\",\n        \"_body\": \"field_media-text_body\",\n        \"image\": 5129,\n        \"_image\": \"field_media-text_image\",\n        \"link\": \"\",\n        \"_link\": \"field_media-text_link\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:acf\/divider {\n    \"id\": \"block_5f5a83737f4e4\",\n    \"name\": \"acf\\\/divider\",\n    \"mode\": \"auto\"\n} \/-->\n\n<!-- wp:heading {\"textAlign\":\"center\",\"level\":1} -->\n<h1 class=\"has-text-align-center\" id=\"h-why-vnsny-choice\">Why VNSNY CHOICE?<\/h1>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph {\"align\":\"left\"} -->\n<p class=\"has-text-align-left\">Life has enough disruptions. 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                    "post_title": "Home",
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                    "post_content": "<!-- wp:paragraph -->\n<p>You can request an application for Medicaid by phone, by mail or in person through your local department of social services (LDSS). VNSNY CHOICE representatives can help you understand if you are eligible, and then guide you through every step of the application process.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>You can also complete the application yourself by going online to the ACCESS NY Health Care website and following the instructions at:&nbsp;<a href=\"https:\/\/nystateofhealth.ny.gov\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/nystateofhealth.ny.gov<\/a>. Applications and assistance in filling them out can also be obtained by calling New York Health Options at <a href=\"tel:1-855-693-6765\">1-855-693-6765<\/a>.&nbsp;&nbsp;<br><br>You will need:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>Proof of age, like a birth certificate<\/li><li>Proof of citizenship or alien status*<\/li><li>Four weeks of recent paycheck stubs (if you are working)<\/li><li>Proof of your income from sources like Social Security, Supplemental Security Income (SSI), Veterans (VA) benefits, retirement, Unemployment Insurance Benefits (UIB), Child Support payments<\/li><li>If you or anyone who lives with you is 65 years old or older, certified blind, or certified disabled, you need to give information on bank accounts, insurance policies and other &nbsp;resources<\/li><li>Proof of where you live, like a rent receipt, landlord statement, mortgage statement, or envelope from mail you received recently<\/li><li>Insurance benefit card or the policy (if you have any other health insurance)<\/li><li>Medicare Benefit Card (the red, white and blue card)<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:paragraph -->\n<p>New York State Medicaid information: <a href=\"http:\/\/www.health.ny.gov\/health_care\/medicaid\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.health.ny.gov\/health_care\/medicaid\/<\/a>.<br><br>&nbsp;* Medicaid coverage is available, regardless of alien status, if you are pregnant or require treatment for an emergency medical condition (a doctor\u2019s certification is required).<\/p>\n<!-- \/wp:paragraph -->",
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                    "post_date": "2020-07-09 19:37:39",
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                    "post_content": "<p style=\"background: white; margin: .25in 0in .25in 0in;\"><em><span style=\"font-family: 'Arial',sans-serif; color: #333333;\">This notice describes how medical information about you may be used and disclosed. It also describes how you can get access to this information. Please review it carefully.<\/span><\/em><\/p>\n<p>Thank you for being a member of VNSNY CHOICE, an affiliate of the Visiting Nurse Service of New York (VNSNY). VNSNY CHOICE Health Plans include a New York State Medicaid managed long term care plan and an HIV Special Needs Plan under contract with the New York State Department of Health (DOH), as well as Medicare Advantage plans under contract to the United States Centers for Medicare and Medicaid Services (CMS).\u00a0In order for you to obtain services through VNSNY CHOICE, we collect, create and maintain personal health information about you, which includes any individually identifiable information that we obtain from you or others that relates to your past, present or future physical or mental health, the health care you have received, or payment for your health care. VNSNY CHOICE is required by law to maintain the privacy of this information.<\/p>\n<p>We are an Organized Health Care Arrangement, and for the purposes of our privacy practices, are considered a single entity, the VNSNY organized health care arrangement (VNSNY OHCA).\u00a0 The members of the VNSNY OHCA are: the Visiting Nurse Service of New York Home Care, VNSNY Hospice and Palliative Care, Partners in Care, ESPRIT Medical Care, VNSNY Care360\u05af Solutions, and VNSNY CHOICE.<\/p>\n<p>Our Joint Notice of Privacy Practices describes how health information about you may be used and disclosed. It also describes how you can get access to this information.<\/p>\n<p>The Joint Notice of Privacy Practices explains:<\/p>\n<ol>\n<li>How the VNSNY OHCA uses and discloses your health information for treatment, payment, and health care operations;<\/li>\n<li>When your information may be used or disclosed without your consent or authorization;<\/li>\n<li>The special protection for certain records such as HIV related information, genetic information, alcohol and\/or substance abuse records, mental health records and other health information specially protected under state and federal law;<\/li>\n<li>When your authorization is required for other uses and disclosures;<\/li>\n<li>The specific privacy practices for those receiving services from Children\u2019s and Family Services or Mental Health Services; and;<\/li>\n<li>Your rights regarding your health information including but not limited to, the right to receive copies of your health information. For a copy of the <a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2020\/10\/vnsny-joint-notice-of-privacy-practices-ohca.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Joint Notice of Privacy Practices of the VNSNY OHCA, please click here<\/a>.<\/li>\n<\/ol>\n\n<!-- wp:paragraph -->\n<p><strong>Complaints<\/strong>. If you believe your privacy rights have been violated you may file a complaint with the VNSNY Privacy Official, 220 East 42<sup>nd<\/sup> Street, New York, New York 10017. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized or retaliated against by VNSNY for filing a complaint.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong> Changes to this Notice<\/strong>. The Members of the VNSNY OHCA may change the terms of this Notice of Privacy Practices at any time. If the terms of the Notice are changed, the new terms will apply to all of your health information, whether created or received by the VNSNY OHCA before or after the date on which the Notice is changed. Any updates to the Notice will be made available on this website.<\/p>\n<!-- \/wp:paragraph -->\n\n<p><strong>Effective November 1, 2020; Last Revised October 2020<\/strong><\/p>\n\n<!-- wp:paragraph -->\n<p><\/p>\n<!-- \/wp:paragraph -->",
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                    "post_content": "<!-- wp:acf\/hero {\n    \"id\": \"block_60243fe0d0efa\",\n    \"name\": \"acf\\\/hero\",\n    \"data\": {\n        \"background_image_image\": 924,\n        \"_background_image_image\": \"field_hero_background_image_image\",\n        \"background_image_caption\": \"\",\n        \"_background_image_caption\": \"field_hero_background_image_caption\",\n        \"background_image\": \"\",\n        \"_background_image\": \"field_hero_background_image\",\n        \"heading\": \"Get the Medicare-Medicaid Plan You Need to Live Safely in the Comfort of Your Home.\",\n        \"_heading\": \"field_hero_heading\",\n        \"subheading\": \"$0 PREMIUMS<br>$0 COPAYS\",\n        \"_subheading\": \"field_hero_subheading\",\n        \"text\": \"\",\n        \"_text\": \"field_hero_text\",\n        \"button\": \"\",\n        \"_button\": \"field_hero_button\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\",\n    \"className\": \"gold-h2s text-left\"\n} \/-->\n\n<!-- wp:columns -->\n<div class=\"wp-block-columns\"><!-- wp:column {\"className\":\"container\"} -->\n<div class=\"wp-block-column container\"><!-- wp:columns -->\n<div class=\"wp-block-columns\"><!-- wp:column -->\n<div class=\"wp-block-column\"><!-- wp:paragraph {\"className\":\"is-style-width-66\"} -->\n<p class=\"is-style-width-66\">VNSNY CHOICE Total (HMO D-SNP) is a Medicare-Medicaid Long Term Care plan that covers doctors, hospitals, prescription drugs and more. Plus, it provides the services you need to live safely in your home. Additional Total benefits include:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:freeform -->\n<ul class=\"feature-list\">\n<li>\n<div class=\"list-icon\"><img src=\"\/wp-content\/themes\/vnsny-choice\/assets\/dist\/img\/icons\/list-icon-apple.png\" alt=\"Apple Icon\" width=\"40px\"><\/div>\n<div><strong class=\"text-secondary\">Up to $132\/month for over-the-counter (OTC) items and groceries<\/strong><\/div>\n<\/li>\n<li>\n<div class=\"list-icon\"><img src=\"\/wp-content\/themes\/vnsny-choice\/assets\/dist\/img\/icons\/list-icon-bus.png\" alt=\"Bus Icon\" width=\"40px\"><\/div>\n<div>Unlimited rides to medical appointments<\/div>\n<\/li>\n<li>\n<div class=\"list-icon\"><img src=\"\/wp-content\/themes\/vnsny-choice\/assets\/dist\/img\/icons\/list-icon-tele.png\" alt=\"Telecommunication Icon\" width=\"40px\"><\/div>\n<div>Telehealth services<\/div>\n<\/li>\n<li>\n<div class=\"list-icon\"><img src=\"\/wp-content\/themes\/vnsny-choice\/assets\/dist\/img\/icons\/list-icon-doc.png\" alt=\"Doctor Icon\" width=\"40px\"><\/div>\n<div>Physical therapy visits<\/div>\n<\/li>\n<li>\n<div class=\"list-icon\"><img src=\"\/wp-content\/themes\/vnsny-choice\/assets\/dist\/img\/icons\/list-icon-assist.png\" alt=\"Assistance Icon\" width=\"40px\"><\/div>\n<div>Consumer Directed Personal Assistance Services (CDPAS)<\/div>\n<\/li>\n<li>\n<div class=\"list-icon\"><img src=\"\/wp-content\/themes\/vnsny-choice\/assets\/dist\/img\/icons\/list-icon-services.png\" alt=\"Medical Serivices Icon\" width=\"40px\"><\/div>\n<div>Skilled nursing services, personal care, rehab therapies, and more<\/div>\n<\/li>\n<li>\n<div class=\"list-icon\"><img src=\"\/wp-content\/themes\/vnsny-choice\/assets\/dist\/img\/icons\/list-icon-glasses.png\" alt=\"Glasses Icon\" width=\"40px\"><\/div>\n<div>$300\/year for eyeglasses (frames and lenses) and contacts<\/div>\n<\/li>\n<li>\n<div class=\"list-icon\"><img src=\"\/wp-content\/themes\/vnsny-choice\/assets\/dist\/img\/icons\/list-icon-accup.png\" alt=\"Acupuncture Icon\" width=\"40px\"><\/div>\n<div>Up to 30 acupuncture visits\/year &amp; more^<\/div>\n<\/li>\n<li>\n<div class=\"list-icon\"><img src=\"\/wp-content\/themes\/vnsny-choice\/assets\/dist\/img\/icons\/list-icon-dental.png\" alt=\"Dental Icon\" width=\"40px\"><\/div>\n<div>Dental coverage<\/div>\n<\/li>\n<\/ul>\n<!-- \/wp:freeform --><\/div>\n<!-- \/wp:column -->\n\n<!-- wp:column {\"className\":\"clmn-rounded\"} -->\n<div class=\"wp-block-column clmn-rounded\"><!-- wp:html -->\n<p>Call today to learn more or to enroll in Total!<br><span class=\"phone-number\"><a href=\"tel:1-718-4CHOICE\">1-718-4CHOICE<\/a><br>(<a href=\"tel:1-718-424-6423\">1-718-424-6423<\/a>) (TTY: <a href=\"tel:711\">711<\/a>)<\/span> 8:00 am to 8:00 pm, 7 days a week<\/p>\n<!-- \/wp:html -->\n\n<!-- wp:html -->\n<div class=\"header-line\">\n<div>Or,<\/div>\n<\/div>\n<!-- \/wp:html -->\n\n<!-- wp:paragraph -->\n<p>Fill in this form to have a VNSNY CHOICE representative contact you about the Total plan.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:gravityforms\/form {\"formId\":\"1\",\"title\":false,\"ajax\":true} \/-->\n\n<!-- wp:paragraph -->\n<p><\/p>\n<!-- \/wp:paragraph --><\/div>\n<!-- \/wp:column --><\/div>\n<!-- \/wp:columns --><\/div>\n<!-- \/wp:column --><\/div>\n<!-- \/wp:columns -->\n\n<!-- wp:paragraph -->\n<p><\/p>\n<!-- \/wp:paragraph -->",
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                    "post_title": "Living Well",
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                    "post_date": "2020-09-25 20:05:00",
                    "post_date_gmt": "2020-09-25 20:05:00",
                    "post_content": "<!-- wp:acf\/hero {\n    \"id\": \"block_5f189b8757435\",\n    \"name\": \"acf\\\/hero\",\n    \"data\": {\n        \"background_image_image\": \"\",\n        \"_background_image_image\": \"field_hero_background_image_image\",\n        \"background_image_caption\": \"\",\n        \"_background_image_caption\": \"field_hero_background_image_caption\",\n        \"background_image\": \"\",\n        \"_background_image\": \"field_hero_background_image\",\n        \"heading\": \"Member Resources \",\n        \"_heading\": \"field_hero_heading\",\n        \"subheading\": \"\",\n        \"_subheading\": \"field_hero_subheading\",\n        \"text\": \"\",\n        \"_text\": \"field_hero_text\",\n        \"button\": \"\",\n        \"_button\": \"field_hero_button\"\n    },\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:acf\/plan-set {\n    \"id\": \"block_5f187c5691cbf\",\n    \"name\": \"acf\\\/plan-set\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_plan-set_heading\",\n        \"subheading\": \"\",\n        \"_subheading\": \"field_plan-set_subheading\",\n        \"bottom_plan_active\": \"0\",\n        \"_bottom_plan_active\": \"field_plan-set_bottom_plan_active\",\n        \"cards_0_heading\": \"VNSNY CHOICE Total (HMO D-SNP)\",\n        \"_cards_0_heading\": \"field_plan-set_cards_heading\",\n        \"cards_0_description\": \"\",\n        \"_cards_0_description\": \"field_plan-set_cards_description\",\n        \"cards_0_button\": {\n            \"title\": \"Find Total Plan Member Resources\",\n            \"url\": \"https:\\\/\\\/www.vnsnychoice.org\\\/for-members-vnsny-choice-total\\\/\",\n            \"target\": \"\"\n        },\n        \"_cards_0_button\": \"field_plan-set_cards_button\",\n        \"cards_0_disable_exit_notifier\": \"0\",\n        \"_cards_0_disable_exit_notifier\": \"field_plan-set_cards_disable_exit_notifier\",\n        \"cards_0_rich_text\": \"\",\n        \"_cards_0_rich_text\": \"field_plan-set_cards_rich_text\",\n        \"cards_1_heading\": \"VNSNY CHOICE MLTC\",\n        \"_cards_1_heading\": \"field_plan-set_cards_heading\",\n        \"cards_1_description\": \"\",\n        \"_cards_1_description\": \"field_plan-set_cards_description\",\n        \"cards_1_button\": {\n            \"title\": \"Find MLTC Plan Member Resources\",\n            \"url\": \"https:\\\/\\\/www.vnsnychoice.org\\\/for-members-mltc-resources\\\/\",\n            \"target\": \"\"\n        },\n        \"_cards_1_button\": \"field_plan-set_cards_button\",\n        \"cards_1_disable_exit_notifier\": \"0\",\n        \"_cards_1_disable_exit_notifier\": \"field_plan-set_cards_disable_exit_notifier\",\n        \"cards_1_rich_text\": \"\",\n        \"_cards_1_rich_text\": \"field_plan-set_cards_rich_text\",\n        \"cards\": 2,\n        \"_cards\": \"field_plan-set_cards\",\n        \"button\": \"\",\n        \"_button\": \"field_plan-set_button\"\n    },\n    \"mode\": \"edit\"\n} \/-->",
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                    "post_date": "2020-08-03 19:33:45",
                    "post_date_gmt": "2020-08-03 19:33:45",
                    "post_content": "<!-- wp:paragraph -->\n<p><strong>SERVICE AUTHORIZATIONS<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>A member or provider can request Prior Authorization for a new service, whether for a new authorization period or within an existing authorization period, or a request to change a service as determined in the plan of care for a new authorization period.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Expedited Prior Authorization Request will be decided within 3 business days of receipt of request for services if the plan determines or the provider indicates that a delay would seriously jeopardize the member\u2019s life or health or ability to attain, maintain, or regain maximum function.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Standard Prior Authorization Request will be decided within 3 business days of receipt of all necessary information, but no more than 14 days of receipt of request for services<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>A Concurrent Review is a request by the member or provider on the member\u2019s behalf for additional services that are currently authorized or homecare following an inpatient hospitalization.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Expedited Concurrent Review Request will be decided within 1 business day of receipt of all necessary information but no more than 3 business days of receipt of request for services.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Standard Concurrent Review Request will be decided within 1 business day of receipt of all necessary information, but no more than 14 days of receipt of request for services.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>In the case of a request for Medicaid home health care covered services following an inpatient admission, 1 business day after receipt of necessary of necessary information; except when the day subsequent to the request for services falls on a weekend or holiday, 72 hours after receipt of necessary information; but in any event no more than three business days after receipt of the request for services.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Extension up to 14 calendar days may be requested by the member or provider on the member\u2019s behalf written or verbal. The plan may also initiate an extension if it can justify need for additional information and if the extension is in the member\u2019s interest.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>If the plan denies a member\u2019s request for an expedited review, the plan will handle as a standard review. Members or providers may appeal plan decisions (see appeal procedures below).<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>The State of New York has created a participant ombudsman program called the Independent Consumer Advocacy Network (ICAN) to provide Participants free, confidential assistance on any services offered by VNSNY CHOICE MLTC. ICAN may be reached toll-free at&nbsp;1-844-614-8800 or online at&nbsp;<a href=\"http:\/\/www.icannys.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.icannys.org<\/a>.<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>FILING AN APPEAL<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>An appeal is the type of complaint you make when you want us to reconsider or change a plan decision. For example, you could file an appeal if:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>We refuse to cover or pay for a service you think we should cover.<\/li><li>We or one of our providers refuse to give you a service you think should be covered.<\/li><li>We or one of our plan providers reduces or cuts back on a service you have been receiving.<\/li><li>You think we are stopping your coverage for a service too soon.<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:paragraph -->\n<p>To file an appeal, write to:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>VNSNY CHOICE<br>MLTC Grievance and Appeals<br>P.O. Box 445<br>Elmsford, NY 10523<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>An appeal may be filed orally or in writing. Appeals must be requested within sixty (60) days of the date of the notice of adverse benefit determination.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>Aid Continuing while appealing a decision about your care:<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Enrollees have the right upon timely filing of an appeal \u2014 10 days of the notice of adverse benefit determination or by the effective date of the adverse determination, whichever is later, for Aid Continuing. Aid Continuing applies when:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>If the plan decides to terminate, suspend or reduce a previously authorized service during the period for which a service was approved; or<\/li><li>If a member is in receipt of long term services and supports or nursing home services (long or short) and the plan decides to partially approve, terminate or suspend, or reduce the level or quantity of long term services and supports or nursing home stay (long and short) for a subsequent authorization period of such service.&nbsp;&nbsp;<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:paragraph -->\n<p>You can also call Member Services at 1-888-867-6555 (TTY\/TDD users, please call 711), if you need help filing an action appeal. Interpreter services are also available.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>WHAT IS THE DIFFERENCE BETWEEN A \"STANDARD\" AND AN \"EXPEDITED\" APPEAL FOR MEDICAL CARE?<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>If you or your provider feels that taking the time for a standard appeal could result in a serious problem to your health or life, you may ask for an expedited review of your appeal of the adverse benefit determination. We will respond to you within 72 hours of receiving your appeal request. The review period may be extended up to 14 days if you request an extension or if we need more information and the delay is in your best interest.&nbsp;The plan will make all reasonable efforts to give prompt oral notice of an extension and written notice within 2 calendar days. A decision about whether we will cover medical care can be a \"standard decision\" that is made within the standard time frame of 30 calendar days of receipt of the appeal request. The plan will send a written acknowledgment of appeal within 15 days of receipt. If a decision is reached before the written acknowledgment is sent, the plan will include the written acknowledgment with the notice of decision (one notice).<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>WHAT IF A MEMBER\u2019S REQUEST FOR AN EXPEDITED REVIEW IS DENIED?<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>If the Plan denies a member\u2019s request to file an expedited appeal, it will process the request under the standard timeframe and make a determination within 30 calendar days. The Plan will notify the member orally that their expedited request will be handled under the standard timeframe and will send a written notice of our decision to deny the expedited appeal request within 2 calendar days of receiving the request.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>WHAT IS A STATE FAIR HEARING?<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Members have the right to request a State Fair Hearing and have their case reviewed by an Administrative Law Judge from the NYS Office of Temporary and Disability Assistance (OTDA) if the Plan\u2019s decision about an appeal is not in the member\u2019s favor. A Fair Hearing must be requested within 120 days of the plan\u2019s appeal decision. OTDA will issue a written decision to either uphold or reverse the plan\u2019s decision. However, the State of New York requires that member exhaust the plan\u2019s internal appeal process before a fair hearing is requested.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>WHAT IS AN EXTERNAL APPEAL?<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>If an appeal is denied because it is determined that the service is not medically necessary or is experimental or investigational, members may file an external appeal with New York State.&nbsp;Members have the right to file an external appeal within 4 months of the notice of appeal decision. The external appeal is decided by external reviewers who do not work for us or New York State. These reviewers are qualified people approved by New York State. You do not have to pay for an external appeal. Your external appeal will be decided within 30 days. More time (up to 5 business days) may be needed if the external appeal reviewer asks for more information. You can get a faster decision (expedited external appeal) if your doctor can say that a delay will cause serious harm to your health to your health. The external appeal reviewer will decide an expedited appeal in 3 calendar days or less. The reviewer will tell you and the plan the decision right away by phone or fax; followed by a letter with the decision. You may request both a State Fair Hearing and external appeal. If you ask for both a Fair Hearing and external appeal, the decision of the Fair Hearing Officer is the final decision.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>FILING A COMPLAINT<\/strong><br><br>A complaint is an expression of dissatisfaction with any matter other than a \u201cPlan Decision\u201d by the member or provider on the member\u2019s behalf about care and treatment. For example, you could file a complaint if:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>You are having a problem with the quality of your care.<\/li><li>You are unable to reach someone by phone or get the information you need.<\/li><li>You have trouble scheduling appointments in a timely manner.<\/li><li>You have a problem with your doctor\u2019s office, whether that is its condition or cleanliness, or you are kept too long in the waiting room.<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:paragraph -->\n<p><strong>Expedited and Standard Complaint and Complaint Appeal<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>The plan will send a written acknowledgment of complaint within 15 business days of receipt. If a decision is reached before the written acknowledgment is sent, the plan may include the written acknowledgment with the notice of decision (one notice).<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>An expedited complaint will be decided as fast as the member\u2019s condition requires, but no more than 48 hours of receipt of all necessary information or 7 calendar days of receipt of the complaint. The Plan will notify members of the decision by phone and in writing within 3 business days of the decision.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>A Standard complaint will be decided 45 calendar days of receipt of all necessary information but no more than 60 calendar days of receipt of the complaint.&nbsp;<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Members have 60 business days after receipt of a complaint decision to file a written complaint appeal. Expedited complaint appeals will be decided within 2 business days of receipt of all necessary information. Standard complaint appeals will be decided within 30 business days of receipt of all necessary information. There is no further level after a complaint appeal.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>You can file a grievance orally by calling Member Services at 1-888-867-6555. (TTY\/TDD users please call 711). Interpreter services are also available or in writing at:<br>VNSNY CHOICE<br>MLTC Grievance and Appeals<br>P.O. Box 445<br>Elmsford, NY 10523<\/p>\n<!-- \/wp:paragraph -->",
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                {
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                    "post_date": "2020-07-09 17:27:49",
                    "post_date_gmt": "2020-07-09 17:27:49",
                    "post_content": "VNSNY CHOICE Health Plans complies with Federal civil rights laws. VNSNY CHOICE does not exclude people or treat them differently because of race, religion, color, national origin, age, disability, sex, sexual orientation, gender identity, or gender expression.\n\nVNSNY CHOICE provides the following:\n<ul>\n \t<li>Free aids and services to people with disabilities to help you communicate with us, such as:\n<ul>\n \t<li>Qualified sign language interpreters<\/li>\n \t<li>Written information in other formats (large print, audio, accessible electronic formats, other formats)<\/li>\n<\/ul>\n<\/li>\n \t<li>Free language services to people whose first language is not English, such as:\n<ul>\n \t<li>Qualified interpreters<\/li>\n \t<li>Information written in other languages<\/li>\n<\/ul>\n<\/li>\n<\/ul>\nIf you need these services, call us at <a href=\"tel:1-888-634-1558\">1-888-634-1558<\/a>. For TTY services, call <a href=\"tel:711\">711<\/a>. If you believe that VNSNY CHOICE has not given you these services or treated you differently because of race, religion, color, national origin, age, disability, sex, sexual orientation, gender identity, or gender expression you can file a grievance with VNSNY CHOICE by:\n<ul>\n \t<li>Mail: VNSNY CHOICE Health Plans, 220 East 42nd Street 3rd Floor, New York, New York 10017<\/li>\n \t<li>By telephone: <a href=\"tel:1-888-634-1558\">1-888-634-1558<\/a>. For TTY services call <a href=\"tel:711\">711<\/a>.<\/li>\n \t<li>In person: 220 East 42nd Street 3rd Floor, New York, New York 10017<\/li>\n \t<li>Fax: 646-459-7729<\/li>\n \t<li>Email: <a href=\"mailto:CivilRightsCoordinator@vnsny.org\">CivilRightsCoordinator@vnsny.org<\/a><\/li>\n \t<li>On the web: <a class=\"noExitNotifier\" href=\"http:\/\/www.vnsny.ethicspoint.com\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/www.vnsny.ethicspoint.com<\/a><\/li>\n<\/ul>\nYou can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by:\n<ul>\n \t<li>Web: Office for Civil Rights Complaint Portal at\n<a href=\"https:\/\/ocrportal.hhs.gov\/ocr\/portal\/lobby.jsf\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/ocrportal.hhs.gov\/ocr\/portal\/lobby.jsf<\/a><\/li>\n \t<li>Mail: U.S. Department of Health and Human Services\n200 Independence Avenue SW., Room 509F, HHH Building\nWashington, DC 20201<\/li>\n \t<li>Complaint forms are available at <a href=\"http:\/\/www.hhs.gov\/ocr\/office\/file\/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/www.hhs.gov\/ocr\/office\/file\/index.html<\/a><\/li>\n \t<li>Phone: <a href=\"tel:1-800-368-1019\">1-800-368-1019<\/a> (TTY\/TDD: <a href=\"tel:1-800-537-7597\">1-800-537-7697<\/a>)<\/li>\n<\/ul>\n<h3><strong>Multi-language Interpreter Services<\/strong><\/h3>\nATTENTION:\u00a0 Language assistance services, free of charge, are available to you.\nCall 1-866-783-1444 (TTY: 711).\n\nATENCI\u00d3N: si habla espa\u00f1ol, tiene a su disposici\u00f3n servicios gratuitos de asistencia ling\u00fc\u00edstica. Llame al <a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (TTY: <a href=\"tel:711\">711<\/a>).\n\n\u6ce8\u610f\uff1a\u5982\u679c\u60a8\u4f7f\u7528\u7e41\u9ad4\u4e2d\u6587\uff0c\u60a8\u53ef\u4ee5\u514d\u8cbb\u7372\u5f97\u8a9e\u8a00\u63f4\u52a9\u670d\u52d9\u3002\u8acb\u81f4\u96fb <a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (TTY: <a href=\"tel:711\">711<\/a>))\u3002\n\n\u0412\u041d\u0418\u041c\u0410\u041d\u0418\u0415:\u00a0 \u0415\u0441\u043b\u0438 \u0432\u044b \u0433\u043e\u0432\u043e\u0440\u0438\u0442\u0435 \u043d\u0430 \u0440\u0443\u0441\u0441\u043a\u043e\u043c \u044f\u0437\u044b\u043a\u0435, \u0442\u043e \u0432\u0430\u043c \u0434\u043e\u0441\u0442\u0443\u043f\u043d\u044b \u0431\u0435\u0441\u043f\u043b\u0430\u0442\u043d\u044b\u0435 \u0443\u0441\u043b\u0443\u0433\u0438 \u043f\u0435\u0440\u0435\u0432\u043e\u0434\u0430.\u00a0 \u0417\u0432\u043e\u043d\u0438\u0442\u0435 <a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (\u0442\u0435\u043b\u0435\u0442\u0430\u0439\u043f: <a href=\"tel:711\">711<\/a>).\n\nATANSYON:\u00a0 Si w pale Krey\u00f2l Ayisyen, gen s\u00e8vis \u00e8d pou lang ki disponib gratis pou ou.\u00a0 Rele <a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (TTY: <a href=\"tel:711\">711<\/a>).\n\n\uc8fc\uc758:\u00a0 \ud55c\uad6d\uc5b4\ub97c \uc0ac\uc6a9\ud558\uc2dc\ub294 \uacbd\uc6b0, \uc5b8\uc5b4 \uc9c0\uc6d0 \uc11c\ube44\uc2a4\ub97c \ubb34\ub8cc\ub85c \uc774\uc6a9\ud558\uc2e4 \uc218 \uc788\uc2b5\ub2c8\ub2e4.\n<a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (TTY: <a href=\"tel:711\">711<\/a>)\ubc88\uc73c\ub85c \uc804\ud654\ud574 \uc8fc\uc2ed\uc2dc\uc624.\n\nATTENZIONE:\u00a0 In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti.\u00a0 Chiamare il numero <a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (TTY: <a href=\"tel:711\">711<\/a>).\n<p dir=\"RTL\">\u05d0\u05d5\u05d9\u05e4\u05de\u05e2\u05e8\u05e7\u05d6\u05d0\u05dd: \u05d0\u05d5\u05d9\u05d1 \u05d0\u05d9\u05e8 \u05e8\u05e2\u05d3\u05d8 \u05d0\u05d9\u05d3\u05d9\u05e9, \u05d6\u05e2\u05e0\u05e2\u05df \u05e4\u05d0\u05e8\u05d4\u05d0\u05df \u05e4\u05d0\u05e8 \u05d0\u05d9\u05d9\u05da \u05e9\u05e4\u05e8\u05d0\u05da \u05d4\u05d9\u05dc\u05e3 \u05e1\u05e2\u05e8\u05d5\u05d5\u05d9\u05e1\u05e2\u05e1 \u05e4\u05e8\u05d9\u05d9 \u05e4\u05d5\u05df \u05d0\u05e4\u05e6\u05d0\u05dc. \u05e8\u05d5\u05e4\n<a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (TTY: <a href=\"tel:711\">711<\/a>)<\/p>\n\u09b2\u0995\u09cd\u09b7\u09cd\u09af \u0995\u09b0\u09c1\u09a8\u0983 \u09af\u09a6\u09bf \u0986\u09aa\u09a8\u09bf \u09ac\u09be\u0982\u09b2\u09be, \u0995\u09a5\u09be \u09ac\u09b2\u09a4\u09c7 \u09aa\u09be\u09b0\u09c7\u09a8, \u09a4\u09be\u09b9\u09b2\u09c7 \u09a8\u09bf\u0983\u0996\u09b0\u099a\u09be\u09df \u09ad\u09be\u09b7\u09be \u09b8\u09b9\u09be\u09af\u09bc\u09a4\u09be \u09aa\u09b0\u09bf\u09b7\u09c7\u09ac\u09be \u0989\u09aa\u09b2\u09ac\u09cd\u09a7 \u0986\u099b\u09c7\u0964 \u09ab\u09cb\u09a8 \u0995\u09b0\u09c1\u09a8 <a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (TTY: <a href=\"tel:711\">711<\/a>)\n\nUWAGA:\u00a0 Je\u017celi m\u00f3wisz po polsku, mo\u017cesz skorzysta\u0107 z bezp\u0142atnej pomocy j\u0119zykowej.\u00a0 Zadzwo\u0144 pod numer <a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (TTY: <a href=\"tel:711\">711<\/a>).\n<p dir=\"RTL\">\u0645\u0644\u062d\u0648\u0638\u0629:\u00a0 \u0625\u0630\u0627 \u0643\u0646\u062a \u062a\u062a\u062d\u062f\u062b \u0627\u0630\u0643\u0631 \u0627\u0644\u0644\u063a\u0629\u060c \u0641\u0625\u0646 \u062e\u062f\u0645\u0627\u062a \u0627\u0644\u0645\u0633\u0627\u0639\u062f\u0629 \u0627\u0644\u0644\u063a\u0648\u064a\u0629 \u062a\u062a\u0648\u0627\u0641\u0631 \u0644\u0643 \u0628\u0627\u0644\u0645\u062c\u0627\u0646.\u00a0 \u0627\u062a\u0635\u0644 \u0628\u0631\u0642\u0645 1-866-783-1444 (\u0631\u0642\u0645 \u0647\u0627\u062a\u0641 \u0627\u0644\u0635\u0645 \u0648\u0627\u0644\u0628\u0643\u0645: 1<span dir=\"LTR\">71<\/span>.<\/p>\nATTENTION :\u00a0 Si vous parlez fran\u00e7ais, des services d'aide linguistique vous sont propos\u00e9s gratuitement. Appelez le <a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a>\u00a0(ATS : <a href=\"tel:711\">711<\/a>).\n<p dir=\"RTL\">\u062e\u0628\u0631\u062f\u0627\u0631: \u0627\u06af\u0631 \u0622\u067e \u0627\u0631\u062f\u0648 \u0628\u0648\u0644\u062a\u06d2 \u06c1\u06cc\u06ba\u060c \u062a\u0648 \u0622\u067e \u06a9\u0648 \u0632\u0628\u0627\u0646 \u06a9\u06cc \u0645\u062f\u062f \u06a9\u06cc \u062e\u062f\u0645\u0627\u062a \u0645\u0641\u062a \u0645\u06cc\u06ba \u062f\u0633\u062a\u06cc\u0627\u0628 \u06c1\u06cc\u06ba \u06d4 \u06a9\u0627\u0644 \u06a9\u0631\u06cc\u06ba\u00a0<span dir=\"LTR\">1-866-783-1444\u00a0 (TTY: 711).<\/span><\/p>\nPAUNAWA:\u00a0 Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.\u00a0 Tumawag sa <a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (TTY: <a href=\"tel:711\">711<\/a>).\n\n\u03a0\u03a1\u039f\u03a3\u039f\u03a7\u0397: \u0391\u03bd \u03bc\u03b9\u03bb\u03ac\u03c4\u03b5 \u03b5\u03bb\u03bb\u03b7\u03bd\u03b9\u03ba\u03ac, \u03c3\u03c4\u03b7 \u03b4\u03b9\u03ac\u03b8\u03b5\u03c3\u03ae \u03c3\u03b1\u03c2 \u03b2\u03c1\u03af\u03c3\u03ba\u03bf\u03bd\u03c4\u03b1\u03b9 \u03c5\u03c0\u03b7\u03c1\u03b5\u03c3\u03af\u03b5\u03c2 \u03b3\u03bb\u03c9\u03c3\u03c3\u03b9\u03ba\u03ae\u03c2 \u03c5\u03c0\u03bf\u03c3\u03c4\u03ae\u03c1\u03b9\u03be\u03b7\u03c2, \u03bf\u03b9 \u03bf\u03c0\u03bf\u03af\u03b5\u03c2 \u03c0\u03b1\u03c1\u03ad\u03c7\u03bf\u03bd\u03c4\u03b1\u03b9 \u03b4\u03c9\u03c1\u03b5\u03ac\u03bd. \u039a\u03b1\u03bb\u03ad\u03c3\u03c4\u03b5 <a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (TTY: <a href=\"tel:711\">711<\/a>).\n\nKUJDES:\u00a0 N\u00ebse flitni shqip, p\u00ebr ju ka n\u00eb dispozicion sh\u00ebrbime t\u00eb asistenc\u00ebs gjuh\u00ebsore, pa pages\u00eb.\u00a0 Telefononi n\u00eb <a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (TTY: <a href=\"tel:711\">711<\/a>).\n\nCH\u00da \u00dd:\u00a0 N\u1ebfu b\u1ea1n n\u00f3i Ti\u1ebfng Vi\u1ec7t, c\u00f3 c\u00e1c d\u1ecbch v\u1ee5 h\u1ed7 tr\u1ee3 ng\u00f4n ng\u1eef mi\u1ec5n ph\u00ed d\u00e0nh cho b\u1ea1n.\u00a0 G\u1ecdi s\u1ed1 <a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (TTY: <a href=\"tel:711\">711<\/a>).\n\nACHTUNG:\u00a0 Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verf\u00fcgung.\u00a0 Rufnummer: <a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (TTY: <a href=\"tel:711\">711<\/a>).\n\n\u0927\u094d\u092f\u093e\u0928 \u0926\u0947\u0902:\u00a0 \u092f\u0926\u093f \u0906\u092a \u0939\u093f\u0902\u0926\u0940 \u092c\u094b\u0932\u0924\u0947 \u0939\u0948\u0902 \u0924\u094b \u0906\u092a\u0915\u0947 \u0932\u093f\u090f \u092e\u0941\u092b\u094d\u0924 \u092e\u0947\u0902 \u092d\u093e\u0937\u093e \u0938\u0939\u093e\u092f\u0924\u093e \u0938\u0947\u0935\u093e\u090f\u0902 \u0909\u092a\u0932\u092c\u094d\u0927 \u0939\u0948\u0902\u0964 <a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (TTY: <a href=\"tel:711\">711<\/a>) \u092a\u0930 \u0915\u0949\u0932 \u0915\u0930\u0947\u0902\u0964\n\nATEN\u00c7\u00c3O:\u00a0 Se fala portugu\u00eas, encontram-se dispon\u00edveis servi\u00e7os lingu\u00edsticos, gr\u00e1tis.\u00a0 Ligue para <a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (TTY: <a href=\"tel:711\">711<\/a>).\n\n\u6ce8\u610f\u4e8b\u9805\uff1a\u65e5\u672c\u8a9e\u3092\u8a71\u3055\u308c\u308b\u5834\u5408\u3001\u7121\u6599\u306e\u8a00\u8a9e\u652f\u63f4\u3092\u3054\u5229\u7528\u3044\u305f\u3060\u3051\u307e\u3059\u3002<a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a> (TTY: <a href=\"tel:711\">711<\/a>)\u307e\u3067\u3001\u304a\u96fb\u8a71\u306b\u3066\u3054\u9023\u7d61\u304f\u3060\u3055\u3044\u3002",
                    "post_title": "NOTICE OF NON-DISCRIMINATION",
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                    "post_name": "nondiscrimination-notice",
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                    "post_modified": "2020-11-09 20:33:28",
                    "post_modified_gmt": "2020-11-10 01:33:28",
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                {
                    "ID": 2577,
                    "post_author": "6",
                    "post_date": "2020-09-01 19:18:12",
                    "post_date_gmt": "2020-09-01 19:18:12",
                    "post_content": "<!-- wp:paragraph -->\n<p>YOUR SAFETY MATTERS! NEW OPIOID SAFETY RULES.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Beginning January 1, 2019, there is an important change that may affect you.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>In order to improve the safety of prescription medications and prevent prescription drug abuse, we are required to follow certain rules, known as&nbsp;<em>opioid safety edits<\/em>&nbsp;and provide a Drug Management Program for some types of medications.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>When will safety rules apply to you?<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>When you go to fill an existing opioid prescription, you will only be able to get a 7-day supply of medication. If your prescription is for more than 7 days, you will need to work with your doctor to get a new written prescription, which follows New York State requirements (explained below).<\/li><li>If you reach a certain pain medication dose, some prescriptions may be stopped by our system, if it\u2019s determined that the amount of medication being filled may be unsafe for you. In some cases, the pharmacist may be able to provide you with the medication upon speaking with your doctor. In other cases, you or your prescriber will need to request a&nbsp;<strong>prior authorization<\/strong>&nbsp;by calling the following number at&nbsp;<a href=\"tel:1-888-672-7205\">1-888-672-7205<\/a>. We have a specific coverage request form to assist you and your doctor with this process. The form may be found on the following page of our website <a href=\"https:\/\/www.vnsnychoice.org\/for-members-vnsny-choice-total\/forms\/\">www.vnsnychoice.org\/for-members-vnsny-choice-total\/forms<\/a>.<\/li><li>If VNSNY CHOICE decides you are at risk for misusing or abusing your opioid or benzodiazepine (i.e., Valium or Xanax) medications, we may limit how you can get these medications. This is known as a \u201cDrug Management Program\u201d with limitations that may:<ul><li>Require you to get&nbsp;<strong><em>all&nbsp;<\/em><\/strong>your prescriptions for opioid or benzodiazepine medications from one pharmacy of your choice,<\/li><li>Require you to get&nbsp;<strong><em>all<\/em><\/strong>&nbsp;your prescriptions for opioid or benzodiazepine medications from one doctor of your choice,<\/li><li>Limit the amount of opioid or benzodiazepine medications we will cover for you.<\/li><\/ul><\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:paragraph -->\n<p><strong>How will we tell you if these limitations apply to you?<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>If VNSNY CHOICE and your doctor decide that one or more of these limitations should apply to you, we will send you a letter in advance with this information. A response may be required from you and it\u2019s an important part of helping us make sure that this Drug Management Program meets your needs.<br><br>For additional information, please review the\u00a0<a href=\"https:\/\/www.medicare.gov\/drug-coverage-part-d\/what-medicare-part-d-drug-plans-cover\/drug-plan-coverage-rules\" target=\"_blank\" rel=\"noreferrer noopener\">CMS Medicare Part D Opioid Policies<\/a>.\u00a0<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>If you have any questions, please contact us at the number below. We\u2019re here to help.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Call&nbsp;<a href=\"tel:1-866-783-1444\">1-866-783-1444<\/a>&nbsp;(TTY: 711)<br>7 days a week, 8 am - 8 pm<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>For Prior Authorization:&nbsp;<br><a href=\"tel:1-888-672-7205\">1-888-672-7205<\/a><br>24 hours a day, 7 days a week (TTY: 711)<br>Fax:&nbsp;<a href=\"tel:1-858-790-7100\">1-858-790-7100<\/a><\/p>\n<!-- \/wp:paragraph -->",
                    "post_title": "Opioid Notice for Members",
                    "post_excerpt": "",
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                    "post_name": "opioid-notice-for-members",
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                    "post_modified": "2021-06-14 14:04:40",
                    "post_modified_gmt": "2021-06-14 18:04:40",
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                    "guid": "https:\/\/www.vnsnychoice.org\/?page_id=2577",
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                {
                    "ID": 4992,
                    "post_author": "6",
                    "post_date": "2020-10-05 15:32:38",
                    "post_date_gmt": "2020-10-05 19:32:38",
                    "post_content": "<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-effective-1-1-19-medicare-only\"><strong>Effective 1\/1\/19 (Medicare Only)<\/strong><\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>At VNSNY CHOICE Health Plans, our member\u2019s safety is our first priority. That\u2019s why we\u2019re notifying you of an important change that may affect your patients beginning on January 1, 2019.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>In order to prevent prescription drug abuse and improve the safety of prescription medications, CMS (Centers for Medicare and Medicaid Services), is requiring all Part D plans follow opioid safety edits. Below is a summary of the safety edits.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/faq {\n    \"id\": \"block_5f7b734852b7f\",\n    \"name\": \"acf\\\/faq\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_faq_heading\",\n        \"items_0_question\": \"Safety edits for Opioid Na\u00efve Patients \",\n        \"_items_0_question\": \"field_faq_items_question\",\n        \"items_0_answer\": \"Medicare Part D patients who have not filled an opioid prescription recently (such as within the past 60 days) will be limited to a supply of 7 days or less. Limiting the amount dispensed with the first opioid prescription may reduce the risk of a future dependency or overuse of these drugs. Important: This alert will not impact patients who already take opioids.\\r\\n\\r\\nPlease note, there are specific dispensing laws by New York State that are required on prescriptions for opioids, hence pharmacists serving your patients may require new prescriptions to be written for the exact quantity for compliance purposes. For reference, these laws are available on the\u00a0<a href=\\\"http:\\\/\\\/www.op.nysed.gov\\\/prof\\\/pharm\\\/pharmlaw.htm\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\" data-cke-saved-href=\\\"http:\\\/\\\/www.op.nysed.gov\\\/prof\\\/pharm\\\/pharmlaw.htm\\\">New York State Board of Pharmacy website<\\\/a>.\",\n        \"_items_0_answer\": \"field_faq_items_answer\",\n        \"items_1_question\": \"Other types of safety edits\",\n        \"_items_1_question\": \"field_faq_items_question\",\n        \"items_1_answer\": \"If a member reaches a certain pain medication dose, some prescriptions may be stopped by our system, if it\u2019s determined that the amount of medication being filled may be unsafe. Details are below:\\r\\n<ul>\\r\\n \\t<li>At the soft stop, known to be a care co-ordination edit, Morphine Milligram Equivalent (MME) dose per day equal to or exceeding the minimum threshold of 90 MME across a single or multiple opioid-containing claim(s), the pharmacists will reach out to prescribers to gather information on opioid utilization that was noted to document appropriate use and allow for claims to process upon seeking this information. You and your staff are encouraged to provide this information to the pharmacists when contacted so there is no interruption in necessary therapies for the beneficiary.<\\\/li>\\r\\n \\t<li>At the hard stop, Morphine Milligram Equivalent (MME) dose per day equal to or exceeding a hard-stop threshold of 200 MME across a single or multiple opioid-containing claim(s), the claim will not process further until a prior authorization is requested from the health plan.<\\\/li>\\r\\n \\t<li>If a patient has filled duplicative long-acting opioid therapies or demonstrated concurrent use of opioids along with benzodiazepines and\\\/or buprenorphine, this can result in a soft stop in which case the Pharmacist may need to speak to you, and upon determining appropriate use, he\\\/she may be able dispense the drug in question. You and your staff are encouraged to provide this information to the pharmacists when contacted so there is no interruption in necessary therapies for the beneficiary.<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_1_answer\": \"field_faq_items_answer\",\n        \"items_2_question\": \"Overview of Drug Management Program (required for all Part D plans)\",\n        \"_items_2_question\": \"field_faq_items_question\",\n        \"items_2_answer\": \"<ul>\\r\\n \\t<li>We will review monthly Drug Utilization Evaluation reports that identify members who meet the minimum overutilization management criteria (as per CMS specifications) for \u2018Frequently Abused Drugs\u2019 (FAD) (CMS considers Opioids and benzodiazepines as FADs with the exception of buprenorphine for MAT and injectables) and will perform case management for those members.<\\\/li>\\r\\n \\t<li>Case management will include written prescriber outreach advising the prescriber(s) of your patient\u2019s potential at-risk status and requesting that you provide an attestation of appropriate opioid utilization or of concerns of overutilization.<\\\/li>\\r\\n \\t<li>Three (3) telephone outreach calls will be made to follow-up with the prescriber if no response has been received. We encourage you and your staff to be responsive in a timely manner to these communications, so that we can minimize any disruptions in therapy.\\r\\n<ul>\\r\\n \\t<li><strong>Only if you are in agreement<\\\/strong>\u00a0that the patient is at-risk, we will evaluate if placing a Point of Sale (POS) edit, pharmacy lock-in and\\\/or prescriber lock-in is necessary for the patient\u2019s safety.<\\\/li>\\r\\n \\t<li>If no response is received, the case will be evaluated further if implementing a POS edit or pharmacy lock-in needs to be pursued but we will not implement a prescriber lock-in.<\\\/li>\\r\\n \\t<li>Member\\\/prescriber\\\/pharmacy notifications will be provided prior to any edit\\\/lock-in implementations.<\\\/li>\\r\\n<\\\/ul>\\r\\n<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_2_answer\": \"field_faq_items_answer\",\n        \"items_3_question\": \"To request a prior authorization\",\n        \"_items_3_question\": \"field_faq_items_question\",\n        \"items_3_answer\": \"<ul>\\r\\n \\t<li>You may call 1-888-672-7205<\\\/li>\\r\\n \\t<li>Faxes can be sent to 1-858-790-7100<\\\/li>\\r\\n \\t<li>You may use the \u2018<em>opioid safety edit specific prior authorization request form<\\\/em>\u2019 that is available on\u00a0<a href=\\\"\\\/for-health-professionals-overview\\\/all-forms\\\/\\\" data-cke-saved-href=\\\"\\\/health-professionals\\\/prior-authorization-request-forms\\\">our website<\\\/a>.<\\\/li>\\r\\n<\\\/ul>\\r\\nWe encourage you to use this form to make sure we receive all the information necessary to evaluate the case and provide an appropriate outcome. You and your patient will be notified once we have made a decision on the case.\",\n        \"_items_3_answer\": \"field_faq_items_answer\",\n        \"items_4_question\": \"Other Important Points\",\n        \"_items_4_question\": \"field_faq_items_question\",\n        \"items_4_answer\": \"<ul>\\r\\n \\t<li>Opioid safety edits are being established based on guidance from CMS and are independent of the plan\u2019s formulary and UM restrictions. Both are treated separately of each other.<\\\/li>\\r\\n \\t<li>Known exceptions such as patients with Cancer diagnosis, residents in LTC facilities, or elected hospice status will not be subjected to these edits. Additionally, any beneficiaries who have existent prior authorizations with the plan that have demonstrated medical necessity will also be exempted from these requirements and their prior authorizations will be evaluated by plan (by contacting prescribing providers if necessary) for any extension of authorizations in order to minimize disruption in therapy. If your patients need to be exempted from these safety edits for any medical necessity, you may contact us through contact means provided below and request prior authorizations ahead of time.<\\\/li>\\r\\n \\t<li>Opioid safety edits and the Drug Management Program are being established to provide collaborative care to beneficiaries keeping their safety in mind and are not intended as prescribing limits. Prescriber\u2019s professional judgement and statements for medical necessity that are provided in any form of communications and methods by prescribers will be honored and considered on case management reviews and prior authorization case reviews to ensure beneficiaries\u2019 access to necessary therapies is not limited in any way.<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_4_answer\": \"field_faq_items_answer\",\n        \"items_5_question\": \"CMS Resources: 2020 Medicare Part D Opioid Policies\",\n        \"_items_5_question\": \"field_faq_items_question\",\n        \"items_5_answer\": \"Please review this\u00a0<a href=\\\"\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/CMS-Opioid-Pharmacist-Tip-Sheet.pdf\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\" data-cke-saved-href=\\\"\\\/sites\\\/default\\\/files\\\/safer-use-of-opioid-pain-medication.pdf\\\">CMS Tip Sheet<\\\/a>.\",\n        \"_items_5_answer\": \"field_faq_items_answer\",\n        \"items_6_question\": \"Training Resource: REMS Program\",\n        \"_items_6_question\": \"field_faq_items_question\",\n        \"items_6_answer\": \"<ul>\\r\\n \\t<li>On September 18, 2018, the Food and Drug Administration (FDA) approved the Opioid Analgesic REMS Program as one among the many strategies and efforts to reduce the risk of abuse, misuse, addiction, overdose, and deaths due to prescription opioid analgesics.<\\\/li>\\r\\n \\t<li>The REMS program requires that training be made available to all health care providers (HCPs) who are involved in the management of patients with pain, including nurses and pharmacists. To meet this requirement, drug companies with approved opioid analgesics will provide unrestricted grants to accredited continuing education providers for the development of education courses for HCPs based on the FDA\u2019s Opioid Analgesic REMS Education Blueprint for Health Care Providers Involved in the Treatment and Monitoring of Patients with Pain.\\r\\n\\r\\nWe encourage you and your prescribing staff to visit this webpage for more information on how to access the continuing education trainings: <a href=\\\"https:\\\/\\\/www.fda.gov\\\/Drugs\\\/DrugSafety\\\/InformationbyDrugClass\\\/ucm163647.htm\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\" data-cke-saved-href=\\\"https:\\\/\\\/www.fda.gov\\\/Drugs\\\/DrugSafety\\\/InformationbyDrugClass\\\/ucm163647.htm\\\">https:\\\/\\\/www.fda.gov\\\/Drugs\\\/DrugSafety\\\/InformationbyDrugClass\\\/ucm163647.htm<\\\/a>.<\\\/li>\\r\\n<\\\/ul>\",\n        \"_items_6_answer\": \"field_faq_items_answer\",\n        \"items\": 7,\n        \"_items\": \"field_faq_items\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:paragraph -->\n<p><strong>Useful Contact Information<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Provider Services: <a href=\"tel:1-866-783-0222\">1-866-783-0222<\/a><br>Monday \u2013 Friday, 8 am \u2013 5 pm<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>Request for Prior Authorization from MedImpact:<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>VNSNY CHOICE Total (HMO D-SNP): <a href=\"tel:1-888-672-7205\">1-888-672-7205<\/a><\/p>\n<!-- \/wp:paragraph -->",
                    "post_title": "Opioid Safety Edits",
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                    "post_date": "2020-07-21 14:08:41",
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                    "post_content": "<!-- wp:acf\/plan-set {\n    \"id\": \"block_5f16f721f7c69\",\n    \"name\": \"acf\\\/plan-set\",\n    \"data\": {\n        \"heading\": \"Choose the plan that is best for you\",\n        \"_heading\": \"field_plan-set_heading\",\n        \"subheading\": \"\",\n        \"_subheading\": \"field_plan-set_subheading\",\n        \"bottom_plan_active\": \"1\",\n        \"_bottom_plan_active\": \"field_plan-set_bottom_plan_active\",\n        \"cards_0_heading\": \"VNSNY CHOICE Total (HMO D-SNP)\",\n        \"_cards_0_heading\": \"field_plan-set_cards_heading\",\n        \"cards_0_description\": \"A Medicare Advantage plan and a Medicaid Advantage Plus plan. Brings together Medicare and Medicaid benefits in an all-in-one plan for people who need long-term help with daily activities.\",\n        \"_cards_0_description\": \"field_plan-set_cards_description\",\n        \"cards_0_button\": {\n            \"title\": \"Learn More\",\n            \"url\": \"https:\\\/\\\/www.vnsnychoice.org\\\/our-plans\\\/choice-total\\\/\",\n            \"target\": \"\"\n        },\n        \"_cards_0_button\": \"field_plan-set_cards_button\",\n        \"cards_0_disable_exit_notifier\": \"0\",\n        \"_cards_0_disable_exit_notifier\": \"field_plan-set_cards_disable_exit_notifier\",\n        \"cards_0_rich_text\": \"You may be eligible if you meet all of the following:\\r\\n<ul>\\r\\n \\t<li>At least 18 years old<\\\/li>\\r\\n \\t<li>Eligible for Medicaid<\\\/li>\\r\\n \\t<li>Eligible for Medicare Part A and Part B<\\\/li>\\r\\n \\t<li>In need of long-term care, for more than 120 days, based on a functional assessment. (Must be eligible for nursing home level of care, as of time of enrollment, based on the Uniform Assessment System (UAS).)<\\\/li>\\r\\n \\t<li>Able to live safely at home with assistance for Activities of Daily Living, such as bathing, dressing, walking, or preparing food.<\\\/li>\\r\\n \\t<li>Living in the <a href=\\\"\\\/total-service-area\\\">VNSNY CHOICE Total service area<\\\/a><\\\/li>\\r\\n<\\\/ul>\",\n        \"_cards_0_rich_text\": \"field_plan-set_cards_rich_text\",\n        \"cards_1_heading\": \"VNSNY CHOICE MLTC\",\n        \"_cards_1_heading\": \"field_plan-set_cards_heading\",\n        \"cards_1_description\": \"A Medicaid Managed Long Term Care plan. Provides long-term help with daily activities for people who are not eligible for Medicare or want to keep it separate. \",\n        \"_cards_1_description\": \"field_plan-set_cards_description\",\n        \"cards_1_button\": {\n            \"title\": \"Learn More\",\n            \"url\": \"\\\/our-plans\\\/vnsny-choice-mltc\\\/\",\n            \"target\": \"\"\n        },\n        \"_cards_1_button\": \"field_plan-set_cards_button\",\n        \"cards_1_disable_exit_notifier\": \"0\",\n        \"_cards_1_disable_exit_notifier\": \"field_plan-set_cards_disable_exit_notifier\",\n        \"cards_1_rich_text\": \"You may be eligible if you meet all of the following:\\r\\n<ul>\\r\\n \\t<li>At least 18 years old<\\\/li>\\r\\n \\t<li>Eligible for Medicaid<\\\/li>\\r\\n \\t<li>In need of community-based long-term care (for a continuous period of 120 days) based on a functional assessment<\\\/li>\\r\\n \\t<li>Able to remain safely at home with assistance for Activities of Daily Living, such as bathing, dressing, walking, or preparing food.<\\\/li>\\r\\n \\t<li>Living in the\u00a0<a href=\\\"\\\/mltc-service-area\\\/\\\">VNSNY CHOICE MLTC service area<\\\/a><\\\/li>\\r\\n<\\\/ul>\",\n        \"_cards_1_rich_text\": \"field_plan-set_cards_rich_text\",\n        \"cards\": 2,\n        \"_cards\": \"field_plan-set_cards\",\n        \"plan_card_image\": 416,\n        \"_plan_card_image\": \"field_plan-set_plan_card_image\",\n        \"plan_card_heading\": \"SelectHealth\",\n        \"_plan_card_heading\": \"field_plan-set_plan_card_heading\",\n        \"plan_card_description\": \"A specialized Medicaid plan for people living with HIV, individuals of transgender experience or gender non-conforming, or homeless individuals, regardless of HIV status.\",\n        \"_plan_card_description\": \"field_plan-set_plan_card_description\",\n        \"plan_card_link\": {\n            \"title\": \"Learn more at the SelectHealth website \",\n            \"url\": \"https:\\\/\\\/www.selecthealthny.org\",\n            \"target\": \"_blank\"\n        },\n        \"_plan_card_link\": \"field_plan-set_plan_card_link\",\n        \"plan_card\": \"\",\n        \"_plan_card\": \"field_plan-set_plan_card\",\n        \"button\": \"\",\n        \"_button\": \"field_plan-set_button\"\n    },\n    \"mode\": \"edit\"\n} \/-->",
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                            "post_date": "2020-07-24 14:28:55",
                            "post_date_gmt": "2020-07-24 14:28:55",
                            "post_content": "<!-- wp:paragraph -->\n<p>VNSNY CHOICE MLTC is a Medicaid plan designed for New Yorkers who want to remain in their own homes and communities, but need help with daily activities such as bathing, dressing, walking, and preparing food. In fact, CHOICE MLTC helps members live safely and independently at home, and stay out of a nursing home, for as long as possible.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>When you join CHOICE MLTC, you\u2019ll have a team of specialized health professionals working together to manage all your care. Led by your own Care Manager\u2014a Registered Nurse or Licensed Social Worker\u2014your CHOICE Care Team develops and coordinates a personalized care plan to meet all your health needs.<br><br>For you, your family and your doctor, it\u2019s great to know there\u2019s always one person who has a complete picture of your care. <\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/divider {\n    \"id\": \"block_5f4ef99150152\",\n    \"name\": \"acf\\\/divider\",\n    \"align\": \"\",\n    \"mode\": \"auto\"\n} \/-->\n\n<!-- wp:pullquote -->\n<figure class=\"wp-block-pullquote\"><blockquote><p>All of this, and you\u2019ll pay no monthly premiums, no deductibles, and no copays for services you receive from our network of providers.<\/p><\/blockquote><\/figure>\n<!-- \/wp:pullquote -->\n\n<!-- wp:acf\/divider {\n    \"id\": \"block_5f4ef99f50153\",\n    \"name\": \"acf\\\/divider\",\n    \"align\": \"\",\n    \"mode\": \"auto\"\n} \/-->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-vnsny-choice-at-your-side-on-your-side\">VNSNY CHOICE: at your side, on your side<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>In a confusing health care world, you can count on your CHOICE Care Team to be your allies. To work with your doctors, help set up appointments, monitor your medications, and talk with you and your family so you all understand your health conditions and your treatment.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Our teams know the New York health care system inside-out, so they can cut through the red tape and make sure you get all the services you qualify for. Plus, we have a 24\/7 Nurse Support Line to make sure you can reach a health professional live, any time day or night.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 id=\"h-mltc-benefits-at-a-glance\">MLTC Benefits at a Glance<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>VNSNY CHOICE MLTC provides the Medicaid long-term care and other health-related services you need to live well in the comfort of your home and community. These include:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li><strong>Care coordination by a team of health professionals<\/strong>, led by a Registered Nurse or Licensed Social Worker, depending on your needs. As a member, you will be assigned your own Care Manager who will oversee all of the services you receive and will work with your providers to make sure your care plan meets all your needs.<\/li><li><strong>A care plan tailored to your needs<\/strong>.&nbsp;Your Care Manager will assess your needs and work with you, your family and caregivers, and your physicians to develop a customized plan designed to meet your day-to-day health needs and keep you safe in your home.&nbsp;<\/li><li><strong>Benefit coordination<\/strong>. It can be a challenge to keep straight which services you\u2019re entitled to receive. With VNSNY CHOICE, one phone call connects you to all of the services and benefits you need.<\/li><li><strong>Assistance with daily activities<\/strong>. Getting the help you need with everyday activities like bathing, dressing, walking, or preparing food can make such a huge difference in your quality of life.<\/li><li><strong>Simplicity<\/strong>. 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                            "post_title": "What is VNSNY CHOICE Managed Long Term Care (MLTC)?",
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                                    "post_date": "2020-07-24 16:48:02",
                                    "post_date_gmt": "2020-07-24 16:48:02",
                                    "post_content": "<!-- wp:paragraph -->\n<p>Find out more about VNSNY CHOICE MLTC benefits and services.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/faq {\n    \"id\": \"block_5f50f091a0816\",\n    \"name\": \"acf\\\/faq\",\n    \"data\": {\n        \"heading\": \"\",\n        \"_heading\": \"field_faq_heading\",\n        \"items_0_question\": \"What services are covered by MLTC?\",\n        \"_items_0_question\": \"field_faq_items_question\",\n        \"items_0_answer\": \"VNSNY CHOICE MLTC provides all the Medicaid long-term care and other health-related services you need to live safely and independently at home and in your community, including:\\r\\n<ul>\\r\\n \\t<li>Care coordination by a Registered Nurse<\\\/li>\\r\\n \\t<li>A care plan tailored to your needs<\\\/li>\\r\\n \\t<li>Benefit coordination<\\\/li>\\r\\n \\t<li>Assistance with daily activities such as dressing, bathing, and preparing food<\\\/li>\\r\\n<\\\/ul>\\r\\nFor more detailed information on MLTC benefits, please visit <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/find-a-plan\\\/long-term-care\\\/mltc-benefits\\\">Your MLTC Benefits<\\\/a>.\",\n        \"_items_0_answer\": \"field_faq_items_answer\",\n        \"items_1_question\": \"Will enrolling in MLTC affect my Medicaid and\\\/or Medicare coverage?\",\n        \"_items_1_question\": \"field_faq_items_question\",\n        \"items_1_answer\": \"No. Enrolling in VNSNY CHOICE MLTC will not change your coverage for any important medical benefits, including doctor visits, hospitalizations, emergency room care, prescription drug coverage, and more.\",\n        \"_items_1_answer\": \"field_faq_items_answer\",\n        \"items_2_question\": \"How much does MLTC cost?\",\n        \"_items_2_question\": \"field_faq_items_question\",\n        \"items_2_answer\": \"As a VNSNY CHOICE MLTC member, your services will be paid for by Medicaid.\",\n        \"_items_2_answer\": \"field_faq_items_answer\",\n        \"items_3_question\": \"Who pays for MLTC services?\",\n        \"_items_3_question\": \"field_faq_items_question\",\n        \"items_3_answer\": \"As a VNSNY CHOICE MLTC member, your services will be paid for by Medicaid.\",\n        \"_items_3_answer\": \"field_faq_items_answer\",\n        \"items_4_question\": \"How will I use a doctor in the network?\",\n        \"_items_4_question\": \"field_faq_items_question\",\n        \"items_4_answer\": \"No, VNSNY CHOICE MLTC members are not required to use network physicians.\",\n        \"_items_4_answer\": \"field_faq_items_answer\",\n        \"items_5_question\": \"Can I keep my doctor?\",\n        \"_items_5_question\": \"field_faq_items_question\",\n        \"items_5_answer\": \"Yes, CHOICE staff speak a wide variety of languages, and we do our best to match each member with the staff that meets their needs.\",\n        \"_items_5_answer\": \"field_faq_items_answer\",\n        \"items_6_question\": \"Can you provide service to non-English speakers? \",\n        \"_items_6_question\": \"field_faq_items_question\",\n        \"items_6_answer\": \"Yes, CHOICE staff speak a wide variety of languages, and we do our best to match each member with the staff that meets their needs.\",\n        \"_items_6_answer\": \"field_faq_items_answer\",\n        \"items_7_question\": \"Where can I learn more about Medicaid?\",\n        \"_items_7_question\": \"field_faq_items_question\",\n        \"items_7_answer\": \"For information on what Medicaid is, and whether you may be eligible, please visit <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/what-medicaid\\\">What Is Medicaid? <\\\/a>You\u2019ll find helpful information about applying for Medicaid at <a href=\\\"https:\\\/\\\/www.vnsnychoice.org\\\/how-apply-medicaid\\\">How to Apply for Medicaid.<\\\/a>\",\n        \"_items_7_answer\": \"field_faq_items_answer\",\n        \"items\": 8,\n        \"_items\": \"field_faq_items\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->",
                                    "post_title": "MLTC Frequently Asked Questions",
                                    "post_excerpt": "",
                                    "post_status": "publish",
                                    "comment_status": "closed",
                                    "ping_status": "closed",
                                    "post_password": "",
                                    "post_name": "frequently-asked-questions",
                                    "to_ping": "",
                                    "pinged": "",
                                    "post_modified": "2020-09-03 13:36:54",
                                    "post_modified_gmt": "2020-09-03 13:36:54",
                                    "post_content_filtered": "",
                                    "post_parent": 549,
                                    "guid": "https:\/\/www.vnsnychoice.org\/?page_id=578",
                                    "menu_order": 0,
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                                {
                                    "ID": 569,
                                    "post_author": "3",
                                    "post_date": "2020-07-24 14:57:05",
                                    "post_date_gmt": "2020-07-24 14:57:05",
                                    "post_content": "<!-- wp:paragraph -->\n<p>To enroll in&nbsp;CHOICE MLTC you must be:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>At least 18 years old<\/li><li>Eligible for Medicaid<\/li><li>In need of community-based long-term care (for a continuous period of 120 days) based on a functional assessment<\/li><li>Able to remain safely at home with assistance for Activities of Daily Living (such as bathing, dressing, walking or preparing food)<\/li><li>Living in the service area of the plan*&nbsp;<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:paragraph -->\n<p>You or a member of your family can call us directly to discuss enrollment in the program. If you need help applying for Medicaid, please let us know.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>*The VNSNY CHOICE MLTC service area includes these counties: Albany, Bronx, Columbia, Delaware, Dutchess, Erie, Fulton, Greene, Herkimer, Kings (Brooklyn), Madison, Monroe, Montgomery, Nassau, New York (Manhattan), Oneida, Onondaga, Orange, Otsego, Putnam, Queens, Rensselaer, Richmond (Staten Island), Rockland, Saratoga, Schenectady, Schoharie, Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester.&nbsp;<\/p>\n<!-- \/wp:paragraph -->",
                                    "post_title": "VNSNY CHOICE MLTC Eligibility",
                                    "post_excerpt": "",
                                    "post_status": "publish",
                                    "comment_status": "closed",
                                    "ping_status": "closed",
                                    "post_password": "",
                                    "post_name": "eligibility",
                                    "to_ping": "",
                                    "pinged": "",
                                    "post_modified": "2020-11-05 21:33:49",
                                    "post_modified_gmt": "2020-11-06 02:33:49",
                                    "post_content_filtered": "",
                                    "post_parent": 549,
                                    "guid": "https:\/\/www.vnsnychoice.org\/?page_id=569",
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                                    "post_type": "page",
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                                {
                                    "ID": 571,
                                    "post_author": "3",
                                    "post_date": "2020-07-24 15:54:18",
                                    "post_date_gmt": "2020-07-24 15:54:18",
                                    "post_content": "<!-- wp:paragraph -->\n<p>Looking for more in-depth information about the VNSNY CHOICE MLTC health plan? You\u2019ll find it here. If you have questions about any of the materials listed here, call Member Services at&nbsp;<a href=\"tel:1-718-424-6423\">1-855-AT-CHOICE (<\/a><a href=\"tel:1-855-AT-CHOICE (1-855-282-4642)\">1-855-282-4642)<\/a>&nbsp;(TTY:&nbsp;<a href=\"tel:711\">711<\/a>), 9 am -  5 pm, Monday \u2013 Friday.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/resources {\n    \"id\": \"block_5f1b161609345\",\n    \"name\": \"acf\\\/resources\",\n    \"data\": {\n        \"resource_groups_0_heading\": \"Plan Information \",\n        \"_resource_groups_0_heading\": \"field_resources_resource_groups_heading\",\n        \"resource_groups_0_resources_0_is_external_resource\": \"0\",\n        \"_resource_groups_0_resources_0_is_external_resource\": \"field_resources_resource_groups_resources_is_external_resource\",\n        \"resource_groups_0_resources_0_heading\": \"Member Handbook \",\n        \"_resource_groups_0_resources_0_heading\": \"field_resources_resource_groups_resources_heading\",\n        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                                    "post_title": "VNSNY CHOICE MLTC Forms & Materials",
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                                    "post_modified": "2021-04-15 11:53:51",
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                                {
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                                    "post_date": "2020-07-24 15:55:43",
                                    "post_date_gmt": "2020-07-24 15:55:43",
                                    "post_content": "<!-- wp:paragraph -->\n<p>CHOICE MLTC was created to help you live safely in the comfort of your own home and community, where you belong. To find out more, just call us, or have a family member call us. We\u2019ll be happy to answer any questions you may have about the plan.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/banner-in-body {\n    \"id\": \"block_5fe377da74693\",\n    \"name\": \"acf\\\/banner-in-body\",\n    \"data\": {\n        \"heading\": \"To learn more:\",\n        \"_heading\": \"field_banner-in-body_heading\",\n        \"description\": \"<a href='tel:1-855-282-4642'>1-855-AT CHOICE (1-855-282-4642)<\\\/a><br><a href='tel:711'>TTY users, call: 711<\\\/a><p>9 am &ndash; 5 pm, Monday &ndash; Friday.  <\\\/p>\",\n        \"_description\": \"field_banner-in-body_description\",\n        \"button\": {\n            \"title\": \"Contact Us\",\n            \"url\": \"https:\\\/\\\/www.vnsnychoice.org\\\/contact-us\\\/\",\n            \"target\": \"\"\n        },\n        \"_button\": \"field_banner-in-body_button\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:paragraph -->\n<p><br>For more information on enrolling in an MLTC plan, contact the Conflict-Free Evaluation and Enrollment Center (CFEEC) at <a href=\"tel:1-855-222-8350\">1-855-222-8350<\/a>.&nbsp;TTY: <a href=\"tel:1-888-329-1541\">1-888-329-1541<\/a>.<\/p>\n<!-- \/wp:paragraph -->",
                                    "post_title": "VNSNY CHOICE MLTC How to Enroll",
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                                    "post_modified": "2020-12-23 12:50:23",
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                                {
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                                    "post_date": "2020-07-24 14:50:32",
                                    "post_date_gmt": "2020-07-24 14:50:32",
                                    "post_content": "<!-- wp:paragraph -->\n<p>VNSNY CHOICE MLTC includes all the Medicaid long-term care and other health related services you need to live well at home and in your community, including:<br><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:columns -->\n<div class=\"wp-block-columns\"><!-- wp:column -->\n<div class=\"wp-block-column\"><!-- wp:list -->\n<ul><li>Care coordination from a dedicated &nbsp;Care Manager<\/li><li>Professional nursing care<\/li><li>24-hour\/7-day a week Nurse Support Line<\/li><li>Home health care \u2013 nursing, home health aide, social work<\/li><li>Rehabilitation therapies (physical, occupational, and speech therapy) either at home or at a facility<\/li><li>Medication management<\/li><li>Personal care<\/li><li>Chore service and housekeeping<\/li><li>Personal Emergency Response Systems<\/li><li>Transportation to health-related appointments<\/li><li>Home-delivered meals<br>&nbsp;<\/li><\/ul>\n<!-- \/wp:list --><\/div>\n<!-- \/wp:column -->\n\n<!-- wp:column -->\n<div class=\"wp-block-column\"><!-- wp:list -->\n<ul id=\"block-339ff4e6-da88-4d5c-81ac-5837b922d162\"><li>Nutritional counseling<\/li><li>Adult day health care<\/li><li>Social day care<\/li><li>Medical equipment and supplies<\/li><li>Respiratory therapy and oxygen<\/li><li>Home safety modifications\/improvements<\/li><li>Prosthetics and orthotics<\/li><li>Dental care<\/li><li>Eye exams and glasses<\/li><li>Foot care<\/li><li>Hearing exams and hearing aids<\/li><li>Nursing home care (certain Medicaid restrictions may apply)<\/li><li>Consumer Directed Personal Assistance Program<\/li><\/ul>\n<!-- \/wp:list --><\/div>\n<!-- \/wp:column --><\/div>\n<!-- \/wp:columns -->",
                                    "post_title": "Your MLTC Benefits",
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                                    "post_modified": "2020-09-28 23:27:29",
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                        {
                            "ID": 406,
                            "post_author": "3",
                            "post_date": "2020-07-21 14:51:08",
                            "post_date_gmt": "2020-07-21 14:51:08",
                            "post_content": "<!-- wp:paragraph -->\n<p>If you need long-term help with daily activities to live safely at home, it\u2019s no longer necessary to have separate Medicare and Medicaid plans. VNSNY CHOICE Total combines Medicare Advantage and Medicaid Long-Term Care benefits into one easy-to-use health plan.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/divider {\n    \"id\": \"block_5f7f8e0a162fd\",\n    \"name\": \"acf\\\/divider\",\n    \"align\": \"\",\n    \"mode\": \"auto\"\n} \/-->\n\n<!-- wp:acf\/media-text {\n    \"id\": \"block_5f7f8da9294b4\",\n    \"name\": \"acf\\\/media-text\",\n    \"data\": {\n        \"align_media_right\": \"0\",\n        \"_align_media_right\": \"field_media-text_align_media_right\",\n        \"is_youtube_video\": \"0\",\n        \"_is_youtube_video\": \"field_media-text_is_youtube_video\",\n        \"heading\": \"A Reputation for Quality \",\n        \"_heading\": \"field_media-text_heading\",\n        \"body\": \"<p>VNSNY CHOICE Total (HMO D-SNP) is rated 4 stars by the Centers for Medicare and Medicaid Services and New York State Department of Health.*<\\\/p>\\r\\n\\r\\n\\r\\n<p><sup>*2019 A Consumer\u2019s Guide to Managed Long-Term Care in New York City.<\\\/sup><\\\/p>\",\n        \"_body\": \"field_media-text_body\",\n        \"image\": 5168,\n        \"_image\": \"field_media-text_image\",\n        \"link\": \"\",\n        \"_link\": \"field_media-text_link\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:acf\/divider {\n    \"id\": \"block_5f4ef4613d0ad\",\n    \"name\": \"acf\\\/divider\",\n    \"align\": \"\",\n    \"mode\": \"auto\"\n} \/-->\n\n<!-- wp:paragraph -->\n<p>CHOICE Total was created for people who want to live in the comfort of their own homes and communities but need ongoing help with daily activities like bathing, cooking, dressing, or walking. This two-in-one Medicare-Medicaid plan covers doctors, hospitals, prescription drugs, vision care, dental care, home health aide services, transportation to medical appointments, and much more. And, there\u2019s $0 cost to you.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>With CHOICE Total you have $0 premiums. $0 copays for medical care. And most people have $0 copays for prescription drugs. See more&nbsp;<a href=\"https:\/\/www.vnsnychoice.org\/our-plans\/choice-total\/benefits\/\">CHOICE Total benefits<\/a>.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:buttons {\"align\":\"center\"} -->\n<div class=\"wp-block-buttons aligncenter\"><!-- wp:button {\"className\":\"is-style-outline\"} -->\n<div class=\"wp-block-button is-style-outline\"><a class=\"wp-block-button__link\" href=\"https:\/\/www.vnsnychoice.org\/our-plans\/choice-total\/how-to-enroll\/\">Let's get started<\/a><\/div>\n<!-- \/wp:button --><\/div>\n<!-- \/wp:buttons -->\n\n<!-- wp:acf\/stats {\n    \"id\": \"block_5f4e58e4ea8cd\",\n    \"name\": \"acf\\\/stats\",\n    \"data\": {\n        \"heading\": \"New for 2021\",\n        \"_heading\": \"field_stats_heading\",\n        \"description\": \"\",\n        \"_description\": \"field_stats_description\",\n        \"cards_0_icon\": 3646,\n        \"_cards_0_icon\": \"field_stats_cards_icon\",\n        \"cards_0_superheading\": \"Now groceries, too!\",\n        \"_cards_0_superheading\": \"field_stats_cards_superheading\",\n        \"cards_0_stat\": \"OTC & Grocery\",\n        \"_cards_0_stat\": \"field_stats_cards_stat\",\n        \"cards_0_description\": \"Get up to $1,584\\\/ year ($132 per month).\",\n        \"_cards_0_description\": \"field_stats_cards_description\",\n        \"cards_1_icon\": 4439,\n        \"_cards_1_icon\": \"field_stats_cards_icon\",\n        \"cards_1_superheading\": \"Bigger Benefit\",\n        \"_cards_1_superheading\": \"field_stats_cards_superheading\",\n        \"cards_1_stat\": \"Vision\",\n        \"_cards_1_stat\": \"field_stats_cards_stat\",\n        \"cards_1_description\": \"Up to $300\\\/year for glasses and contacts.\",\n        \"_cards_1_description\": \"field_stats_cards_description\",\n        \"cards_2_icon\": 2565,\n        \"_cards_2_icon\": \"field_stats_cards_icon\",\n        \"cards_2_superheading\": \"New Benefit \",\n        \"_cards_2_superheading\": \"field_stats_cards_superheading\",\n        \"cards_2_stat\": \"Telehealth\",\n        \"_cards_2_stat\": \"field_stats_cards_stat\",\n        \"cards_2_description\": \"Online doctor visits and more.\",\n        \"_cards_2_description\": \"field_stats_cards_description\",\n        \"cards\": 3,\n        \"_cards\": \"field_stats_cards\",\n        \"button\": \"\",\n        \"_button\": \"field_stats_button\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:html \/-->\n\n<!-- wp:acf\/media-text {\n    \"id\": \"block_5f4dab3a4412d\",\n    \"name\": \"acf\\\/media-text\",\n    \"data\": {\n        \"align_media_right\": \"1\",\n        \"_align_media_right\": \"field_media-text_align_media_right\",\n        \"is_youtube_video\": \"0\",\n        \"_is_youtube_video\": \"field_media-text_is_youtube_video\",\n        \"heading\": \"Easy to Use\",\n        \"_heading\": \"field_media-text_heading\",\n        \"body\": \"CHOICE Total brings together Medicare Advantage and Medicaid Managed Long Term Care (MLTC) into one simple health plan. 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                            "post_title": "What is VNSNY CHOICE Total (HMO D-SNP)?",
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                            "post_name": "choice-total",
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                            "post_modified": "2021-04-05 16:10:17",
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                                    "post_date": "2020-07-23 21:41:20",
                                    "post_date_gmt": "2020-07-23 21:41:20",
                                    "post_content": "<!-- wp:paragraph -->\n<p>If you or someone you know would like to enroll in VNSNY CHOICE Total (HMO D-SNP), please call us at the number below. We can answer any questions about the plan or schedule a call for you to discuss the plan and your options with one of our education enrollment specialists. If you decide the plan is right for you, our specialists can help you enroll right over the phone.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Please note: Eligibility is determined through a clinical assessment. You must be eligible for nursing home level of care, as of the time of enrollment, based on the Uniform Assessment System (UAS). Final plan enrollment is determined by New York Medicaid Choice.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/banner-in-body {\n    \"id\": \"block_5f52db9841142\",\n    \"name\": \"acf\\\/banner-in-body\",\n    \"data\": {\n        \"heading\": \"To learn more or enroll:\",\n        \"_heading\": \"field_banner-in-body_heading\",\n        \"description\": \"<a href='tel:1-718-4CHOICE'>1-718-4CHOICE (1-718-424-6423)<\\\/a><br><a href='tel:711'>TTY users, call: 711<\\\/a><p>8 am &ndash; 8 pm, 7 days a week.  <\\\/p>\",\n        \"_description\": \"field_banner-in-body_description\",\n        \"button\": {\n            \"title\": \"Contact Us\",\n            \"url\": \"https:\\\/\\\/www.vnsnychoice.org\\\/contact-us\\\/\",\n            \"target\": \"\"\n        },\n        \"_button\": \"field_banner-in-body_button\"\n    },\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:paragraph -->\n<p><\/p>\n<!-- \/wp:paragraph -->",
                                    "post_title": "Getting Started with VNSNY CHOICE Total",
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                                    "post_modified": "2021-02-26 18:36:34",
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                                    "post_date": "2020-07-23 21:33:00",
                                    "post_date_gmt": "2020-07-23 21:33:00",
                                    "post_content": "<!-- wp:paragraph -->\n<p>VNSNY CHOICE Total (HMO D-SNP) covers thousands of drugs. 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                                    "post_title": "Prescription Drug Benefits",
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                                    "post_modified": "2021-05-27 21:25:02",
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                                {
                                    "ID": 460,
                                    "post_author": "3",
                                    "post_date": "2020-07-22 19:49:32",
                                    "post_date_gmt": "2020-07-22 19:49:32",
                                    "post_content": "<!-- wp:paragraph -->\n<p>VNSNY CHOICE Total (HMO D-SNP) combines Medicare Advantage and Medicaid Long Term Care for people who need help with day-to-day tasks (such as bathing, dressing, walking, and preparing food) to remain safely in their homes and communities.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>With VNSNY CHOICE Total there is $0 cost to you. $0 plan premiums, $0 deductibles, and $0 copays for services you receive from our network of providers. And, you can keep your doctors, specialists, and home health aide.*<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:table {\"className\":\"is-style-stripes\"} -->\n<figure class=\"wp-block-table is-style-stripes\"><table><tbody><tr><td><strong>New OTC &amp; Grocery Benefit<\/strong><\/td><\/tr><tr><td>Now you can use CHOICE Total Over the Counter (OTC) &amp; Grocery card to buy a wide selection of grocery items at stores in your community. You can buy the ingredients for your favorite recipes, as well as fruits, vegetables, meats, milk, cheese, cereal, rice and so much more. You\u2019ll get up to $1,584\/ year ($132\/mo) for groceries, over-the-counter medicines and medical supplies.<br><br><\/td><\/tr><\/tbody><\/table><\/figure>\n<!-- \/wp:table -->\n\n<!-- wp:buttons {\"align\":\"center\"} -->\n<div class=\"wp-block-buttons aligncenter\"><!-- wp:button {\"className\":\"is-style-outline\"} -->\n<div class=\"wp-block-button is-style-outline\"><a class=\"wp-block-button__link\" href=\"https:\/\/www.vnsnychoice.org\/our-plans\/choice-total\/how-to-enroll\/\">Ready to enroll?<\/a><\/div>\n<!-- \/wp:button --><\/div>\n<!-- \/wp:buttons -->\n\n<!-- wp:acf\/brochure-table {\n    \"id\": \"block_5f52693ff0c5d\",\n    \"name\": \"acf\\\/brochure-table\",\n    \"data\": {\n        \"heading\": \"VNSNY CHOICE Total Benefits\",\n        \"_heading\": \"field_brochure-table_heading\",\n        \"subheading\": \"2021 Benefits Overview\",\n        \"_subheading\": \"field_brochure-table_subheading\",\n        \"rows_0_icon\": 3171,\n        \"_rows_0_icon\": 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\"field_brochure-table_rows_label\",\n        \"rows_5_data\": \"$0 for routine eye exam, $300\\\/year for eyeglasses (frames and lenses) or contacts\",\n        \"_rows_5_data\": \"field_brochure-table_rows_data\",\n        \"rows_5_colorText\": \"0\",\n        \"_rows_5_colorText\": \"field_brochure-table_rows_colortext\",\n        \"rows_5_newBadge\": \"1\",\n        \"_rows_5_newBadge\": \"field_brochure-table_rows_newbadge\",\n        \"rows_6_icon\": 3175,\n        \"_rows_6_icon\": \"field_brochure-table_rows_icon\",\n        \"rows_6_label\": \"Telehealth service\",\n        \"_rows_6_label\": \"field_brochure-table_rows_label\",\n        \"rows_6_data\": \"$0\",\n        \"_rows_6_data\": \"field_brochure-table_rows_data\",\n        \"rows_6_colorText\": \"0\",\n        \"_rows_6_colorText\": \"field_brochure-table_rows_colortext\",\n        \"rows_6_newBadge\": \"1\",\n        \"_rows_6_newBadge\": \"field_brochure-table_rows_newbadge\",\n        \"rows_7_icon\": 3237,\n      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\"_rows_12_label\": \"field_brochure-table_rows_label\",\n        \"rows_12_data\": \"$0\",\n        \"_rows_12_data\": \"field_brochure-table_rows_data\",\n        \"rows_12_colorText\": \"0\",\n        \"_rows_12_colorText\": \"field_brochure-table_rows_colortext\",\n        \"rows_12_newBadge\": \"0\",\n        \"_rows_12_newBadge\": \"field_brochure-table_rows_newbadge\",\n        \"rows_13_icon\": 3174,\n        \"_rows_13_icon\": \"field_brochure-table_rows_icon\",\n        \"rows_13_label\": \"Worldwide coverage\",\n        \"_rows_13_label\": \"field_brochure-table_rows_label\",\n        \"rows_13_data\": \"Up to $50,000\\\/year for emergency services and urgent care\",\n        \"_rows_13_data\": \"field_brochure-table_rows_data\",\n        \"rows_13_colorText\": \"0\",\n        \"_rows_13_colorText\": \"field_brochure-table_rows_colortext\",\n        \"rows_13_newBadge\": \"0\",\n        \"_rows_13_newBadge\": \"field_brochure-table_rows_newbadge\",\n        \"rows\": 14,\n        \"_rows\": \"field_brochure-table_rows\",\n        \"footnote\": \"&nbsp;\\r\\n\\r\\n*As long as the provider is in the network.\\r\\n**Additional acupuncture visits for chronic low back pain covered by Medicare.\",\n        \"_footnote\": \"field_brochure-table_footnote\"\n    },\n    \"align\": \"\",\n    \"mode\": \"edit\"\n} \/-->\n\n<!-- wp:paragraph -->\n<p>For more information about the many benefits of CHOICE Total, see the Summary of Benefits and Evidence of Coverage in the <a href=\"https:\/\/www.vnsnychoice.org\/our-plans\/choice-total\/member-materials\/\">Member Materials<\/a> section.<\/p>\n<!-- \/wp:paragraph -->",
                                    "post_title": "VNSNY CHOICE Total 2021 Benefits",
                                    "post_excerpt": "",
                                    "post_status": "publish",
                                    "comment_status": "closed",
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                                    "post_name": "benefits",
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                                    "post_modified": "2021-01-22 15:41:24",
                                    "post_modified_gmt": "2021-01-22 20:41:24",
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                                    "post_parent": 406,
                                    "guid": "https:\/\/www.vnsnychoice.org\/?page_id=460",
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                                {
                                    "ID": 412,
                                    "post_author": "3",
                                    "post_date": "2020-07-21 15:22:05",
                                    "post_date_gmt": "2020-07-21 15:22:05",
                                    "post_content": "<!-- wp:table {\"align\":\"center\"} -->\n<figure class=\"wp-block-table aligncenter\"><table><thead><tr><th>You may be eligible for VNSNY CHOICE Total (HMO D-SNP) if you are:<\/th><\/tr><\/thead><tbody><tr><td> At least 18 years old   <\/td><\/tr><tr><td>Eligible for Medicaid<\/td><\/tr><tr><td>Eligible for Medicare Part A and Part B<\/td><\/tr><tr><td>In need of long-term care, for more than 120 days, based on a functional assessment (must be eligible for nursing home level of care, as of time of enrollment, based on the Uniform Assessment System (UAS)).<\/td><\/tr><tr><td>Able to live safely at home with assistance for Activities of Daily Living, such as bathing, dressing, walking, or preparing food.<\/td><\/tr><tr><td>Living in the VNSNY CHOICE Total service area. This service area includes the following counties: the Bronx, Kings (Brooklyn), Nassau, New York (Manhattan), Queens, Richmond (Staten Island), Suffolk, and Westchester.<\/td><\/tr><\/tbody><\/table><\/figure>\n<!-- \/wp:table -->\n\n<!-- wp:paragraph -->\n<p>For more information, please call <a href=\"tel:1-718-424-6423\">1-718-4CHOICE (1-718-424-6423)<\/a>. TTY users, call: <a href=\"tel:711\">711<\/a>.<\/p>\n<!-- \/wp:paragraph -->",
                                    "post_title": "VNSNY CHOICE Total Eligibility",
                                    "post_excerpt": "",
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                                    "post_name": "eligibility",
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                                    "post_modified": "2020-09-30 15:44:17",
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                                {
                                    "ID": 3368,
                                    "post_author": "3",
                                    "post_date": "2020-09-05 18:21:15",
                                    "post_date_gmt": "2020-09-05 18:21:15",
                                    "post_content": "<!-- wp:paragraph -->\n<p>Looking for more in-depth information about the VNSNY CHOICE Total (HMO D-SNP) health plan? You\u2019ll find it here. 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                                    "post_title": "VNSNY CHOICE Total Plan Materials",
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                                    "post_modified": "2020-09-24 19:13:11",
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                                    "post_date": "2020-07-23 19:58:46",
                                    "post_date_gmt": "2020-07-23 19:58:46",
                                    "post_content": "<!-- wp:paragraph -->\n<p>Looking for more in-depth information about the VNSNY CHOICE Total (HMO D-SNP) health plan? You\u2019ll find it here. 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                    "post_date": "2020-07-09 17:22:46",
                    "post_date_gmt": "2020-07-09 17:22:46",
                    "post_content": "<p>VNSNY CHOICE is committed to establishing a culture that promotes prevention, detection and resolution of Fraud Waste and Abuse (\u201cFWA\u201d). \u00a0It is the policy of VNSNY CHOICE that all employees, agents, contractors, officers, directors, and VNSNY CHOICE first tier, downstream, and related entities (\u201cFDRs\u201d) must report potential instances of non-compliance and fraudulent, wasteful, abusive and criminal activity.<\/p>\n\n<h3>WHAT IS FRAUD WASTE AND ABUSE?<\/h3>\n<p><strong>Fraud\u00a0<\/strong>is an intentional misrepresentation of a known fact made for the purpose of obtaining a benefit or financial gain.<\/p>\n<p><strong>Waste\u00a0<\/strong>includes any practice that results in an unnecessary use or consumption of financial or medical resources. \u00a0Waste does not necessarily involve personal gain, but often signifies poor management decisions, practices or controls.<\/p>\n<p><strong>Abuse\u00a0<\/strong>is a practice that is inconsistent with accepted business, financial or medical practices or standards, that results in unnecessary cost or in reimbursement.<\/p>\n<p>Together, Fraud, Waste and Abuse are often referred to as FWA.<\/p>\n<p>Examples of FWA include:\nBy\u00a0<strong>providers<\/strong>:<\/p>\n\n<ul>\n \t<li>Billing for services not provided;<\/li>\n \t<li>Deliberately filing incorrect diagnosis or procedure codes to maximize payment for claims;<\/li>\n \t<li>Quality of care issues;<\/li>\n \t<li>Failure to maintain adequate medical records;<\/li>\n \t<li>Cover-ups in coordination of benefits;<\/li>\n \t<li>Misrepresenting services or dates of service;<\/li>\n \t<li>Billing non-covered services as covered services;<\/li>\n \t<li>An eligible provider billing for services provided by a non-eligible provider or individual;<\/li>\n \t<li>Providing and billing for unnecessary services; or<\/li>\n \t<li>Accepting or offering kickbacks and bribery.<\/li>\n<\/ul>\n<p>By\u00a0<strong>members<\/strong>:<\/p>\n\n<ul>\n \t<li>Loaning a VNSNY CHOICE identification card for use by another person;<\/li>\n \t<li>Altering the amount or date of service on a claim form or prescription receipt;<\/li>\n \t<li>Fabricating claims; or<\/li>\n \t<li>\u201cDoctor shopping\u201d (seeing several providers to obtain frequent drug prescriptions) or excessive trips to the emergency room for narcotics.<\/li>\n<\/ul>\n<p>By\u00a0<strong>non-members<\/strong>:<\/p>\n\n<ul>\n \t<li>Using a stolen VNSNY CHOICE card to obtain medical services or prescriptions; or<\/li>\n \t<li>Engaging in impermissible sales and marketing practices to steer potential members to or from VNSNY CHOICE plans.<\/li>\n<\/ul>\n<p>By VNSNY CHOICE\u00a0<strong>employees<\/strong>:<\/p>\n\n<ul>\n \t<li>Creating false claims or charges;<\/li>\n \t<li>Delaying assignment of a provider to reduce costs;<\/li>\n \t<li>Failing to provide covered services to reduce costs;<\/li>\n \t<li>Engaging in impermissible sales and marketing practices, such as using unapproved promotional materials, falsifying eligibility information, enrolling individuals without their knowledge or offering inducements to members and providers to join; or<\/li>\n \t<li>Changing member or provider addresses to intercept payments<\/li>\n<\/ul>\n<h3>HOW TO REPORT FWA OR COMPLIANCE CONCERNS<\/h3>\n<p>Anonymous Hotline and Online Reporting Tool<\/p>\n<p>VNSNY CHOICE Hotline: (888) 634-1558<\/p>\n<p>Special Investigations Unit: <a href=\"mailto:SIUmailbox@vnsny.org\">SIUmailbox@vnsny.org<\/a><\/p>\n<p>VNSNY Online Reporting Tool:\u00a0<a href=\"http:\/\/www.vnsny.ethicspoint.com\/\" target=\"_blank\" rel=\"noopener noreferrer\">www.vnsny.ethicspoint.com<\/a><\/p>\n<p>Through our Hotline and Online Reporting Tool, individuals can report FWA, compliance concerns or seek guidance about compliance questions:<\/p>\n\n<ul>\n \t<li>24 hours, 7 days a week<\/li>\n \t<li>Anonymously, if you choose<\/li>\n \t<li>Without worry of retaliation or intimidation<\/li>\n<\/ul>\n<p>Any individual may make a report.<\/p>\n<p>When making a report, please provide as much detail as possible, such as names, dates, and a description of the issue. Unless you prefer to remain anonymous, please include your name and telephone number so that we may contact you if we have any questions during our investigation.<\/p>\n\n<h3>VNSNY CHOICE SPECIAL INVESTIGATIONS UNIT<\/h3>\n<p>VNSNY CHOICE has established a Special Investigations Unit (\u201cSIU\u201d) to investigate reports of FWA. \u00a0The SIU includes Special Investigators and data analysts who investigate FWA reports and work with other professionals in the health care industry to identify FWA schemes.<\/p>\n<p>For more information on the VNSNY CHOICE SIU, and tools and processes in place to prevent and detect FWA, please see the\u00a0<a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2021\/04\/CHOICE-Fraud-Waste-Abuse-Dection-Manual.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">VNSNY CHOICE Fraud Detection Manual<\/a> and <a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2021\/04\/VNSNY-CHOICE-Special-Investigation-Unit_Fraud-Waste-Abuse.pdf\" target=\"_blank\" rel=\"noopener\">VNSNY CHOICE Policy and Procedure Manual<\/a>.<\/p>\n\n<h4><strong>From the VNSNY CHOICE SIU:<\/strong><\/h4>\n<p>Be on the lookout for the following common FWA schemes:<\/p>\n\n<h4 data-tadv-p=\"keep\"><strong>Telehealth<\/strong><\/h4>\n<p>As a growing and underregulated industry, <strong>telehealth<\/strong> is ripe for fraud. Like other types of fraud, telehealth fraud schemes are varied and subject to constant change. However, recent events indicate that regulators are currently focused on two major types of telehealth fraud schemes: DME fraud and billing for \u201cvisits\u201d that never occurred or were shorter in duration than the amount billed.<\/p>\n\n<h4><strong>Upcoding<\/strong><\/h4>\n<p><strong>Upcoding\u00a0<\/strong>is a common scheme in which a service provider will bill Medicare, Medicaid and\/or a health plan for services at a greater amount than those that were actually provided. Health care providers engaging in upcoding may submit claims using codes inappropriate for services provided that allow them to be paid a higher rate.<\/p>\n<p>For example:<\/p>\n<p>A member visits their primary care physician and explains symptoms such as a runny nose, coughing and a low-grade fever. The physician completes a brief examination, does not order any tests and prescribes an antibiotic for a simple infection. The member spends a total of 10-15 minutes with the physician. Shortly afterward, the member\u2019s health plan receives a claim from the physician with a code or codes that indicate the physician spent 45 minutes with the member, completed several tests, provided multiple prescriptions and diagnosed the member with several conditions.<\/p>\n\n<h4><strong>Billing for Services Not Rendered<\/strong><\/h4>\n<p><strong>Billing for Services Not Rendered<\/strong>\u00a0occurs when a health care provider submits a claim to a health care plan in an attempt to get paid for services not provided to the member.<\/p>\n<p>For example:<\/p>\n<p>A Durable Medical Equipment supplier did not provide a member a wheelchair ordered, but submits a claim to the health care plan for the wheelchair.<\/p>\n\n<h4><strong>Kickbacks<\/strong><\/h4>\n<p><strong>Member Kickbacks<\/strong>\u00a0occur when any provider, plan member, individual or entity offers any form of compensation to a member in exchange for a member\u2019s information that may allow the party offering the kickback access to health plan payments they otherwise would not have been able to obtain.<\/p>\n<p>For example:<\/p>\n<p>A provider may offer a health plan member some form of compensation in exchange for permission to use for the member's health plan i.d. number to bill for services they never rendered.<\/p>\n<p>A pharmacy offers a member any kind of compensation in exchange for prescriptions written by the member\u2019s physician. In this scheme, the pharmacy pays the member cash for the prescription, keeps the entire prescription without filling it or only gives him a portion of the quantity prescribed, and bills the health plan for the entire prescription<\/p>\n<p>Keep in mind, compensation can be considered anything of value such as money, food, MTA cards, appliances, electronics, cigarettes, etc.<\/p>\n<p>For news release updates from the Office of Inspector General, please visit:\u00a0<a title=\"blocked::http:\/\/oig.hhs.gov\/newsroom\/news-releases\/index.asp\" href=\"http:\/\/oig.hhs.gov\/newsroom\/news-releases\/index.asp\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/oig.hhs.gov\/newsroom\/news-releases\/index.asp<\/a>.<\/p>\n\n<h4><strong>Useful Links<\/strong><strong>:<\/strong><\/h4>\n<p>NYS OMIG:\n<a href=\"http:\/\/www.omig.ny.gov\/consumers\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/www.omig.ny.gov\/consumers<\/a><\/p>\n<p>Health Integrity (NBI MEDIC):\n<a href=\"http:\/\/www.healthintegrity.org\/contracts\/nbi-medic\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/www.healthintegrity.org\/contracts\/nbi-medic<\/a><\/p>\n<p>The Centers for Medicare and Medicaid Services (CMS):\n<a href=\"http:\/\/www.cms.gov\/\" target=\"_blank\" rel=\"noopener noreferrer\">www.cms.gov<\/a><\/p>\n<p>The Office of Inspector General\n<a href=\"https:\/\/oig.hhs.gov\/\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/oig.hhs.gov\/<\/a><\/p>",
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                    "post_date": "2020-06-02 19:39:00",
                    "post_date_gmt": "2020-06-02 19:39:00",
                    "post_content": "<h2>VNSNY CHOICE WEBSITE AND APP PRIVACY POLICY<\/h2>\n<p>This Website and App Privacy Policy (this \u201cPrivacy Policy\u201d) describes the online privacy practices of the Visiting Nurse Service New York, VNSNY CHOICE, and their affiliates (collectively, \u201cVNSNY,\u201d \u201cwe,\u201d or \u201cus\u201d), and applies to anyone who visits or uses our websites and mobile applications, including our sites at <a class=\"noExitNotifier\" href=\"https:\/\/www.vnsny.org\" target=\"_blank\" rel=\"noopener noreferrer\">www.vnsny.org<\/a>, <a class=\"noExitNotifier\" href=\"https:\/\/www.vnsnychoice.org\">www.vnsnychoice.org<\/a>, <a class=\"noExitNotifier\" href=\"https:\/\/www.vnsny.org\/how-we-can-help\/private-care-services\/\" target=\"_blank\" rel=\"noopener noreferrer\">www.partnersincareny.org<\/a>, <a class=\"noExitNotifier\" href=\"https:\/\/www.availity.com\/vns\" target=\"_blank\" rel=\"noopener noreferrer\">www.availity.com\/vns<\/a>, <a class=\"noExitNotifier\" href=\"https:\/\/vnsproviderportal.tmghealth.com\/portal\/home\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/vnsproviderportal.tmghealth.com\/portal\/home<\/a>, any subsequent URL which may replace these websites, all associated websites, URLs and microsites, the Tr\u012bves mobile application, any Facebook or other social media pages created by VNSNY or its affiliates, and any other VNSNY website or mobile application that links to or incorporates this Privacy Policy (collectively, and each individually, the \u201cPlatform\u201d). By accessing the Platform, you indicate that you have read, understand, and agree to be bound by the terms of this Privacy Policy. If at any time you do not agree to this Privacy Policy, please do not use the Platform. Your use of the Platform is also subject to our Terms of Use, which you can access at: <a class=\"noExitNotifier\" href=\"https:\/\/www.vnsny.org\/terms-conditions\/\" target=\"_blank\" rel=\"noopener noreferrer\">www.vnsny.org\/terms-of-use<\/a>. Some portions of the Platform may be subject to different or additional terms of use, which will be communicated to you via the relevant website or mobile application.<\/p>\n<h3>1. Types of Information Collected<\/h3>\n<h4>(a)\u00a0 Personally Identifiable Information<\/h4>\n<p>Personally identifiable information (\u201cPII\u201d) means information that specifically identifies you as an individual, such as your full name, telephone number, email address, postal address or certain account numbers. VNSNY may ask you for certain kinds of PII to provide and promote the various services available through the Platform. You do not have to provide us with PII if you do not want to; however, that may limit your ability to use certain functions of the Platform or to request from VNSNY or to benefit from certain services or information.<\/p>\n<h4>(b) Usage Information<\/h4>\n<p>Whenever you visit or interact with the Platform, we, as well as our third-party service providers, use a variety of technologies that automatically or passively collect information about how you access and use the Platform (\u201cUsage Information\u201d).\u00a0 Usage Information includes your Internet Protocol address or other unique identifier for your device, your device type, your browser type, your operating system, the pages you view on the Platform, the pages you view immediately before and after you access the Platform and the search terms you enter into the Platform. Most Usage Information does not directly identify you and is considered non-personally identifiable information (\u201cNon-PII\u201d); however, if Usage Information is used in a way that could directly identify you, we will treat it as PII.<\/p>\n<p>Several of the functions on the Platform use cookies or similar technologies. A cookie is a small piece of information sent by a website that is saved on your device. If you do not want the Platform to collect information through the use of cookies, you can set your web browser to reject cookies from our websites. Each browser is different, so you should check your browser\u2019s \u201cHelp\u201d menu to learn how to change your cookie preferences. If you reject or block cookies, however, the Platform may not function as intended.<\/p>\n<p>VNSNY may also use \u201cpixel tags\u201d (sometimes called \u201cweb beacons\u201d or \u201cclear gifs\u201d), which are tiny graphic images, on the Platform. Pixel tags may help VNSNY analyze users\u2019 online behavior and measure the effectiveness of the Platform. Pixel tags and cookies in VNSNY\u2019s emails may be used to track your interactions with those messages, such as when you receive, open or click a link in an email message from VNSNY.<\/p>\n<h4>(c) Personal Health Information<\/h4>\n<p>Personal Health Information is the health information about you (which includes any individually identifiable information that we obtain from you or others that relates to your past, present or future physical or mental health, the health care you have received, or payment for your health care) that VNSNY collects, creates and maintains. This information may qualify as \u201cprotected health information,\u201d or \u201cPHI,\u201d under the Health Insurance Portability and Accountability Act of 1996, as amended and its implementing regulations, and Health Information Technology for Economic and Clinical Health Act and its implementing regulations (collectively, \u201cHIPAA\u201d). Such information may include member eligibility and claims data. VNSNY is required by law to maintain the privacy of PHI. VNSNY is also required by law to provide you with a Notice of HIPAA Privacy Rights as to PHI, which can be accessed <a class=\"noExitNotifier\" href=\"https:\/\/www.vnsny.org\/vnsny-hipaa-privacy-notice\/\">here<\/a> and we will comply with the terms as stated there in so far as PHI is communicated or collected through the Platform. For more information about VNSNY\u2019s policies concerning medical information, you can also visit <a href=\"https:\/\/www.vnsnychoice.org\/hipaa-privacy-policy\/\">https:\/\/www.vnsnychoice.org\/hipaa-privacy-policy<\/a>.<\/p>\n<p>Please understand that the terms of the Notice of HIPAA Privacy Rights apply to PHI that we may collect, or that you may share with us, through electronic communications. This includes that in certain circumstances VNSNY may use and disclose your health information without your specific written authorization, as described in the Notice of HIPAA Privacy Rights. It also means that you may consent to use or disclosure of your PHI under other circumstances as well.<\/p>\n<h3>2. Use of Information<\/h3>\n<p>VNSNY uses the information collected from you when you use the Platform for various purposes. These include, without limitation:<\/p>\n<ul>\n<li>to provide the services you request;<\/li>\n<li>to process your application as requested by you;<\/li>\n<li>to follow up with you regarding your interest and\/or use of the VNSNY services;<\/li>\n<li>to keep you informed about the status of your services;<\/li>\n<li>to identify your preferences so VNSNY can notify you of information or products, services and promotions that might be of interest to you;<\/li>\n<li>to personalize your experience on the Platform;<\/li>\n<li>to improve customer service and the overall experience with VNSNY;<\/li>\n<li>to generate and analyze statistics about the preferences of users of the Platform;<\/li>\n<li>to detect, prevent and respond to fraud, intellectual property infringement, violations of our Terms of Use, violations of the law or other misuse of the Platform<\/li>\n<li>to comply with applicable laws, regulations and legal process; and<\/li>\n<li>to communicate with and advertise to users of the Platform and others by email, postal mail, telephone, text message or other means.<\/li>\n<\/ul>\n<p>VNSNY may also combine or aggregate any of the information it collects through the Platform or elsewhere for any of these purposes.<\/p>\n<h3>3. Sharing of Information<\/h3>\n<p>VNSNY may share your PII with any of its parents, subsidiaries, sister companies or other affiliated entities\u00a0 (\u201cRelated Parties\u201d) who have agreed to adhere to the rules set forth in this Privacy Policy, and you may receive communications from those Related Parties regarding their various goods and services that may be of interest to you. You may opt out of receiving such communications by following the directions in any emails you receive from such Related Parties or by contacting us as described below.<\/p>\n<p>By using the Platform, you are deemed to consent to certain limited uses of your PII, including that VNSNY may share your PII under certain circumstances with businesses to help the Platform function or improve VNSNY services. VNSNY may therefore disclose information to outside companies that help promote and bring users like you the services VNSNY offers. For example, VNSNY may work with an outside company to: (a) manage a database of customer information; (b) assist in distributing emails; (c) assist with direct marketing and data collection; (d) provide data storage and analysis; (e) provide fraud prevention; (f) provide customer service by phone and\/or (g) provide other services designed to assist VNSNY in maximizing its business potential and maintaining the Platform. VNSNY requires that these outside companies keep confidential all information VNSNY shares with them and (except as described below with respect to aggregate information or Non-PII) to use the information only to perform their obligations in their agreements with VNSNY.<\/p>\n<p>VNSNY does not share, sell or trade with third parties (other than Related Parties and third parties hired by VNSNY to help operate the Platform or our business) any of your PII or any specific details about you as an individual, except with your consent, as may be needed to operate our business, or as may be required or permitted by law, each as described below.<\/p>\n<p>VNSNY will ask You for certain kinds of PII to provide the various services available through the Platform. This PII includes:<\/p>\n<p>Your <strong>Partners in Care Account \u2013<\/strong> Partners in Care is an affiliate of VNSNY. In order to use and access some portions of the Partners in Care Site, You will have to create a personal account (the \u201cAccount\u201d) with VNSNY, either through the Partners in Care Site or by speaking directly with a VNSNY representative. Once You create an Account, You may access Your Account online at any time to add, delete or change Your information.<\/p>\n<p>In creating Your Partners in Care Account, You authorize VNSNY to store Your name, address, phone number, e-mail address, how quickly You need care, whether You are the patient; Your relationship to the patient, location of care, the patient\u2019s address and phone number, if You are not the patient; whether the patient has needed home care before if they are a first time patient, whether it is Your first time using VNSNY, a checklist of conditions, a payment and insurance checklist and other personal information that You may be asked to provide when You create Your Account. By providing this information to VNSNY, You are authorizing VNSNY to store such information, and You are also authorizing VNSNY to continue to store such information for archival purposes even if You change or delete Your Account or stop using the VNSNY services. This information is used to customize Your experience on the website and to help us begin to create Your Plan of Care. The information is not sold to, or shared with, any person or entity not affiliated with VNSNY; although, as described in more detail below, Partners in Care may provide this information to certain companies hired by VNSNY to help the business function. If You ever use a public computer to login to Your Account on the Platform, You are strongly encouraged to log out at the conclusion of Your session. By doing so, although Your information will still be stored in connection with the Platform, it will not be accessible to anyone else from that computer. As set forth in the Terms of Use, VNSNY will not be responsible for Your failure to take the appropriate steps to keep Your personal account information private.<\/p>\n<p>VNSNY may, from time to time, add account features to other Platforms, and these same policies will apply to such accounts with such Platforms. Your creation of an account with or for such Platforms is deemed an acceptance of these policies and terms.<\/p>\n<p><strong>E-mail List \u2013<\/strong> When You create an Account and You opt-in to receiving e-mail from VNSNY, You will be added to VNSNY\u2019s e-mail list. Your e-mail address will not be sold to, or shared with, anyone who is not affiliated with or working for VNSNY. Your subscription to the e-mail list can be cancelled at any time. To be removed from VNSNY e-mail list, please e-mail VNSNY at <a href=\"mailto:unsubscribe@partnersincareny.org?subject=unsubscribe\">unsubscribe@partnersincareny.org<\/a> and include Your name and e-mail address in the message, or click the unsubscribe button found at the bottom of the e-mails You receive from VNSNY.<\/p>\n<p><strong>Calls to Customer Service\/Participation in Surveys<\/strong> <strong>\u2013<\/strong> If You call VNSNY Customer Service center or participate in one of VNSNY\u2019s User surveys, You may be asked for additional information, such as Your age, interests or service preferences. This information will be stored by VNSNY as well.<\/p>\n<p>VNSNY may share PII when legally required, to cooperate with police investigations or other legal proceedings, to protect against misuse\/unauthorized use of the Platform, to limit VNSNY\u2019s legal liability or to protect the rights, property or safety of other users of the Platform or the public. VNSNY may share PII with outside companies that help bring you the services VNSNY offers. VNSNY may share PII with any successor company, such as a company that acquires VNSNY or its assets, or an affiliate, service provider or other third party to the extent reasonably necessary to proceed with the negotiation or completion of a merger, acquisition or sale of our assets.<\/p>\n<p>In addition, VNSNY may share aggregate reports of user demographics, traffic, patterns and other Non-PII with third parties for any reason. VNSNY may also make such information available, in aggregate form, to marketing partners, advertisers and others in order to assist VNSNY in providing its services and identifying potential customers. Further, the information that VNSNY collects may be used to improve the Platform, to personalize Your online experience, to help VNSNY deliver information to You, to determine the effectiveness of VNSNY\u2019s advertising and for other internal business purposes.<\/p>\n<p>VNSNY may also work with business partners that use tracking and related technologies (such as Facebook\u2019s Custom Audience) to deliver advertisements on VNSNY\u2019s behalf across the Internet. These companies may collect Non-PII about Your visits to the Platform and Your interaction with VNSNY\u2019s communications. VNSNY may combine the information it collects through these companies, cookies and pixel tags with other information including PII (like your email address) VNSNY has collected from You. By using the Platform or agreeing to receive any VNSNY email or newsletter, you agree and consent to VNSNY sharing your email address to Facebook for use solely in connection with its Custom Audience Targeting program. Facebook will match your email address to its database and will display advertisements for VNSNY on your Facebook portal. If you do not wish to see such targeted advertisements, please opt-out of the Custom Audience by <a href=\"https:\/\/www.facebook.com\/business\/help\/1415256572060999\" target=\"_blank\" rel=\"noopener noreferrer\">following the instructions available here<\/a>.<\/p>\n<p><strong>DMD Healthcare Communications Network Privacy Statement<\/strong><\/p>\n<p>This digital service participates in the DMD Healthcare Communication Network (the \u201cNetwork\u201d), and as such has implemented various technologies for universal registration\/login among all Network member websites. These technologies are managed by DMD Marketing Corp. (\u201cDMD\u201d), and may involve the collection, receipt, and sharing of information with DMD, its clients and other Network members. If you would like to understand how this digital service\u2019s participation in the Network affects your privacy, please click here: <a href=\"https:\/\/hcn.health\/privacy-policy\/\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/usersupport.dmdconnects.com\/PrivacyPolicy.htm<\/a>.<\/p>\n<p>Please note that the Network registration\/login system may be different from the registration\/login used by this digital service for other products and services. To the extent that anything in this privacy policy conflicts with the policy for the Network technologies, the conflict will be resolved in favor of the policy applicable to the Network technologies.<\/p>\n<p><strong>Sharing PHI<\/strong><\/p>\n<p>VNSNY may share your PHI as noted in the HIPAA Privacy Notice. This may include sharing such information with qualified healthcare professionals, their staff and others who have agreed to maintain the confidentiality of such information consistent with HIPAA. This includes advising such persons, among other things, as follows:<\/p>\n<p><strong>HIPAA Warning<\/strong><\/p>\n<p>The Platform may provide qualified healthcare professionals with access to patient health information that may qualify as \u201cprotected health information,\u201d or \u201cPHI,\u201d under the Health Insurance Portability and Accountability Act of 1996, as amended and its implementing regulations, and Health Information Technology for Economic and Clinical Health Act and its implementing regulations (collectively, \u201cHIPAA\u201d). Such information may include member eligibility and claims data. You are responsible for ensuring that your use of the Platform complies with the requirements of HIPAA and any other applicable federal or state laws. You should follow appropriate security measures in connection with use of the Platform, including but not limited to:<\/p>\n<ul>\n<li>Logging in only under your user ID<\/li>\n<li>Keeping your login credentials confidential and safe from discovery from others<\/li>\n<li>Logging off from or locking your computer or mobile device when it is unattended<\/li>\n<li>Closing your browser after using the Platform<\/li>\n<li>Contacting us immediately if you suspect that your login credentials have been compromised<\/li>\n<\/ul>\n<p>FAILURE TO COMPLY WITH HIPAA AND OTHER APPLICABLE FEDERAL AND STATE PRIVACY LAWS COULD LEAD TO DISCIPLINARY SANCTIONS, WHICH MAY INCLUDE FINES AND CIVIL OR CRIMINAL PROSECUTION.<\/p>\n<p><strong>Code of Conduct and Provider Manual<\/strong><\/p>\n<p>For users of the Platform who are healthcare providers, or their staff, by using the Platform (including, but not limited to any eligibility verification or claim status tools made available through the Platform), and therefore agreeing to be bound by this Privacy Policy, you also agree to adhere to the applicable requirements of the Visiting Nurse Service of New York <a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2021\/04\/VNSNY-Compliance-Program-Code-of-Conduct.pdf\" target=\"_blank\" rel=\"noopener\">Code of Conduct<\/a> (\u201cCode of Conduct\u201d) available at <a href=\"http:\/\/www.vnsnychoice.org\">www.vnsnychoice.org<\/a> and, if applicable, the VNSNY CHOICE <a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2020\/08\/VNSNY-CHOICE-Provider-Manual.pdf\" target=\"_blank\" rel=\"noopener\">Provider Manual<\/a>, available at <a href=\"http:\/\/www.vnsnychoice.org\">www.vnsnychoice.org<\/a>. Therefore, your use of the Platform indicates that you have read, understand and agree to adhere to the Code of Conduct and the Provider Manual. If you do not agree to adhere to the Code of Contact and Provider Manual, please discontinue access to and use of the Platform.<\/p>\n<p>Finally, please understand that there are portions of the Platform where one may post comments that become available to other users. VNSNY is not responsible for the content of such posts, and cautions you as a user not to disclose in such forums any information that you consider, or wish to remain, private or confidential.<\/p>\n<h3><strong>4. Security of Information<\/strong><\/h3>\n<p>VNSNY uses reasonable physical, electronic and administrative safeguards to maintain the security of PII it collects, including restricting physical access to our offices and computer servers, as well as employing electronic security systems and password protections that guard against unauthorized access. However, the transmission of data over the Internet cannot be guaranteed to be 100% secure. While VNSNY will use reasonable means to protect the security of information you transmit to VNSNY, VNSNY cannot guarantee that such information will not be intercepted by third parties and VNSNY will not be liable for the acts of third parties.<\/p>\n<p>Additionally, please note that email is not encrypted and is not considered to be a secure means of transmitting information, so please do not email VNSNY any confidential, financial or sensitive information.<\/p>\n<h3>5. Links to Other Websites<\/h3>\n<p>The Platform may contain links to websites operated by third parties. This does not mean that VNSNY endorses these third-party websites. VNSNY does not make any representations or warranties about any third-party website you may access through the Platform. Such linked websites are independent from VNSNY, and VNSNY has no control over, or responsibility for, their products, services, information or other activities. In addition, VNSNY\u2019s Privacy Policy may differ from those of these other websites. If you provide personal information at one of those sites, you are subject to the privacy policy of the operator of that website, not the VNSNY Privacy Policy.<\/p>\n<h3>6. Children and Privacy<\/h3>\n<p>The Platform is not meant for children and VNSNY will not knowingly collect any PII from anyone under the age of 18. By providing VNSNY with PII, you are verifying that you are at least 18 years old. Further, if you become aware that a child under your care has provided us PII without your consent, please contact us at the contact information listed below.<\/p>\n<h3>7. Changes to this Privacy Policy<\/h3>\n<p>VNSNY reserves the right to change or update this Privacy Policy by posting such changes or updates to the Platform. Changes will be effective when posted, and we will update the \u201clast updated\u201d date at the bottom of this Privacy Policy to reflect the date of the change. You are advised to consult this Privacy Policy regularly for any changes, and your continued use of the Platform after such changes constitutes acceptance of those changes.<\/p>\n<h3>8. Contact Information<\/h3>\n<p>If you have any questions about this Privacy Policy, please contact us at:<\/p>\n<p>Visiting Nurse Service of New York<br \/>Chief Compliance Officer<br \/>220 East 42nd Street, 6th Floor<br \/>New York, NY 10017<\/p>\n<p><em>This Privacy Policy was last updated September, 2020.<\/em><\/p>\n<div>\u00a0<\/div>\n\n<!-- wp:paragraph -->\n<p><\/p>\n<!-- \/wp:paragraph -->",
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                    "post_content": "<!-- wp:heading -->\n<h2>YOUR VNSNY CHOICE PROVIDER MANUAL<\/h2>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>Here in one PDF document are answers to all your questions about VNSNY CHOICE&nbsp;policies and procedures concerning member care, claims, and authorizations, and&nbsp;everything providers should know about working with us.<br>&nbsp;For more information, please call VNSNY CHOICE Provider Services at 1-866-783-0222 (TTY: 711), Monday \u2013 Friday, 9 am \u2013 5 pm.&nbsp;In the meantime, you may view or&nbsp;<a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual_v4.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">download&nbsp;the entire VNSNY CHOICE Provider Manual (PDF) here<\/a>.&nbsp;&nbsp;Or you may download individual sections and appendices from the VNSNY CHOICE Provider Manual for quick access to the information you need.&nbsp;<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><em>Sections<\/em><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual_v4_Section_1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Section 1 - Programs, Benefits, and Covered Services<\/a><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual_v4_Section_2.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Section 2 - Provider Networks<\/a><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual_v4_Section_3.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Section 3 - Eligibility and Membership<\/a><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual_v4_Section_4.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Section 4 - Quality Improvement Program<\/a><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual_v4_Section_5.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Section 5 - Responsibilities of a PCP<\/a><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider%20Manual_v4_Section_6.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Section 6 - Vendor Management<\/a><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual_v4_Section_7.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Section 7 - Ancillary and Other Special Services<\/a><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual_v4_Section_8.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Section&nbsp;8 - Medical Management<\/a><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual_v4_Section_9.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Section 9 - Care Management<\/a><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual_v4_Section_10.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Section 10 - Grievances and Appeals<\/a><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual_v4_Section_11.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Section 11 - Billings and Claims Processing<\/a><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><em>Appendices<\/em><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual-v4_Appendix_1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Appendix 1 - Provider Team<\/a><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual-v4_Appendix_2.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Appendix 2 - Credentialing<\/a><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual-v4_Appendix_3.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Appendix 3 - Pharmacy<\/a><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual-v4_Appendix_4.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Appendix 4 - Quality Management&nbsp;and Quality&nbsp;Improvement<\/a><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual_v4_Appendix_5.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Appendix 5 - Claims<\/a><br><a href=\"https:\/\/www.vnsnychoice.org\/sites\/default\/files\/2020-CHOICE-Provider-Manual_v4_Appendix_6.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Appendix 6 - Medical Management<\/a><\/p>\n<!-- \/wp:paragraph -->",
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                    "post_content": "<p>These terms of use apply to the websites owned and operated by, or on behalf of, VNSNY CHOICE, including\u00a0<a href=\"http:\/\/www.vnsnychoice.org\/\">www.vnsnychoice.org<\/a>,\u00a0<a href=\"http:\/\/www.selecthealthny.org\/\">www.SelectHealthNY.org<\/a>, <a class=\"noExitNotifier\" href=\"http:\/\/www.availity.com\/vns\" target=\"_blank\" rel=\"noopener\">www.availity.com\/vns<\/a>, and\u00a0<a href=\"https:\/\/vnsproviderportal.tmghealth.com\/portal\/home\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/vnsproviderportal.tmghealth.com\/portal\/home<\/a>\u00a0(collectively, and\u00a0each individually, \"the Site\"). VNSNY CHOICE owns and operates this Site, including all information, communications, articles, text, graphics, opinions, and audio or visual materials (collectively \"contents\"). By using the Site, you indicate that you have read, understand and agree to be bound by these Terms of Use. If you do not agree to be bound by these Terms of Use, please discontinue access to and use of this Site.<\/p>\n<p><strong>THE CONTENTS OF THIS SITE DO NOT CONSTITUTE MEDICAL ADVICE<\/strong><\/p>\n<p>The contents of this site are for informational use only. They do not constitute, and are not intended to substitute for, professional medical advice. The users of this Site are expected to and encouraged to consult with physicians, medical advisors and health care practitioners regarding a specific medical diagnosis or condition or general health issues.<\/p>\n<p>VNSNY CHOICE does not suggest or recommend any procedures, practices, equipment or other items that are components of or related to medical practice.<\/p>\n\n<h3>HIPAA Warning<\/h3>\n<p>This site may provide qualified healthcare professionals with access to patient health information that may qualify as \"protected health information,\" or \"PHI,\" under the Health Insurance Portability and Accountability Act of 1996, as amended and its implementing regulations, and Health Information Technology for Economic and Clinical Health Act and its implementing regulations (collectively, \"HIPAA\"). Such information may include member eligibility and claims data. You are responsible for ensuring that your use of the Site complies with the requirements of HIPAA and any other applicable federal or state laws. You should follow appropriate security measures in connection with use of the Site, including but not limited to:<\/p>\n\n<ul>\n \t<li>Logging in only under your user ID<\/li>\n \t<li>Keeping your login credentials confidential and safe from discovery from others<\/li>\n \t<li>Logging off from or locking your computer when it is unattended<\/li>\n \t<li>Closing your browser after using the Site<\/li>\n \t<li>Contacting us immediately if you suspect that your login credentials have been compromised<\/li>\n<\/ul>\n<p><em>FAILURE TO COMPLY WITH HIPAA AND OTHER APPLICABLE FEDERAL AND STATE PRIVACY LAWS COULD LEAD TO DISCIPLINARY SANCTIONS, WHICH MAY INCLUDE FINES AND CIVIL OR CRIMINAL PROSECUTION.<\/em><\/p>\n\n<h3>CODE OF CONDUCT AND PROVIDER MANUAL<\/h3>\n<p>For users of the Site who are healthcare providers, or their staff, by using the Site (including, but not limited to any eligibility verification or claim status tools made available through the Site), and therefore agreeing to be bound by these Terms of Use, you also agree to adhere to the applicable requirements of the Visiting Nurse Service of New York Code of Conduct (\"Code of Conduct\") available at\u00a0<a href=\"http:\/\/www.vnsnychoice.org\/\">www.vnsnychoice.org<\/a>\u00a0and, if applicable, the VNSNY CHOICE Provider Manual, available at\u00a0<a href=\"http:\/\/www.vnsnychoice.org\/\">www.vnsnychoice.org<\/a>. Therefore, your use of this Site indicates that you have read, understand and agree to adhere to the\u00a0<a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2021\/04\/VNSNY-Compliance-Program-Code-of-Conduct.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Code of Conduct<\/a>\u00a0and the\u00a0<a href=\"https:\/\/www.vnsnychoice.org\/wp-content\/uploads\/2020\/08\/VNSNY-CHOICE-Provider-Manual.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Provider Manual<\/a>. If you do not agree to adhere to the Code of Contact and Provider Manual, please discontinue access to and use of this Site.<\/p>\n\n<h3>LIMITED RIGHT OF USE\/OWNERSHIP OF CONTENTS<\/h3>\n<p>The Site is the property of VNSNY CHOICE and is protected by the United States and international copyright, trademark and other applicable laws. This includes the content, appearance, and design of this Site, as well as the trademarks, products names, graphics, logos, service names, slogans, colors and designs.<\/p>\n<p>You may use and view the materials on the Site in accordance with these Terms of Use. The contents are the intellectual property of VNSNY CHOICE, or are used by VNSNY CHOICE under license from the owner. You may use them for personal and non-commercial uses only. You may not copy, modify, adapt, upload, download, post, transmit, republish, translate, exhibit, display, perform, distribute, participate in the transfer in or sale of, create or derivate works from, reverse engineer or decompile or dissemble or in any way exploit any of the content, including without limitation the HTML or software instructional code, contained in, or forming part of, the Site, in whole or in part, without our prior permission except for your own personal, non-commercial purposes or where otherwise indicated on the Site where found permissible. You may not use the name and trademark \"VNSNY CHOICE\" or other VNSNY CHOICE name, trademark, or service mark or any adaptation thereof for advertising, trade or other commercial or non-commercial purposes.<\/p>\n\n<h3><strong>THIRD-PARTY WEBSITES<\/strong><\/h3>\n<p>For your convenience, the Site may contain links to the websites or third parties from which you may be able to obtain content and\/or download software. Except as otherwise noted, such third-party websites, and such content and software are provided by companies that are not affiliated and are independent of VNSNY CHOICE. VNSNY CHOICE does not endorse or make any representations or warranties concerning such websites, and may not have reviewed such content or software. VNSNY CHOICE has no control over, and assumes no responsibility for, the content, privacy policies, or practices of any third-party site. Therefore, VNSNY CHOICE makes no representation as to the accuracy or any other aspect of the information contained in or on such websites, sources or servers, nor does VNSNY CHOICE necessarily endorse such websites or sources.<\/p>\n<p>By using the VNSNY CHOICE Site, you expressly relieve VNSNY CHOICE from any and all liability arising from your use of any third-party website. Accordingly, we encourage you to be aware when you leave the VNSNY CHOICE Site and to read the terms and conditions and privacy policies of other each other site that you visit.<\/p>\n\n<h3>DISCLAIMER OF WARRANTIES\/LIMITATION OF LIABILITY<\/h3>\n<p>VNSNY CHOICE does not give any warranties, express or implied, regarding the contents, VNSNY CHOICE, and its affiliates and subsidiaries, shall not be liable for any damage including but not limited to direct, indirect, incidental, consequential or other damages resulting from the use of or inability to use this Site. This includes but is not limited to damages for personal injury, including death, or property damage whether the theory of liability is based on contract, tort, products liability or any other legal theory.<\/p>\n<p><em>YOU EXPRESSLY ACKNOWLEDGE THAT USE OF THE SITE IS AT YOUR SOLE RISK. NEITHER VNSNY CHOICE NOR ITS AFFILIATED COMPANIES NOR ANY OF OF THEIR RESPECTIVE EMPLOYEES, AGENTS, THIRD-PARTY CONTENT PROVIDERS OR LICENSORS (COLLECTIVELY THE \"VNSNY CHOICE PARTIES\") WARRANT THAT THE SITE WILL BE UNINTERRUPTED OR ERROR FREE; NOR DO THEY MAKE ANY WARRANTIES AS TO THE RESULTS THAT MAY BE OBTAINED FROM USE OF THE SITE, OR AS TO THE ACCURACY OR RELIABILITY OR CONTENT OF ANY INFORMATION, SERVICE OR MERCHANDISE PROVIDED THROUGH THE SITE. THE SITE IS PROVIDED ON AN \"AS IS\" BASIS WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO, WARRANTIES OF TITLE OR IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE, OTHER THAN THOSE WARRANTIES WHICH ARE IMPLIED BY AND INCAPABLE OF EXCLUSION, RESTRICTION OR MODIFICATION UNDER THE LAWS APPLICABLE TO THIS AGREEMENT.<\/em><\/p>\n<p><em>THIS DISCLAIMER OF LIABILITY APPLIES TO ANY DAMAGES OR INJURY CAUSED BY ANY FAILURE OF PERFORMANCE, ERROR, OMISSION, INTERRUPTION, DELETION, DEFECT, DELAY IN OPERATION OR TRANSMISSION, COMPUTER VIRUS, COMMUNICATION LINE FAILURE, THEFT OR DESTRUCTION OR UNAUTHORIZED ACCESS TO, ALTERATION OF, OR USE OF RECORD, WHETHER FOR BREACH OF CONTRACT, TORTIOUS BEHAVIOR, NEGLIGENCE OR UNDER ANY OTHER CAUSE OF ACTION. YOU SPECIFICALLY ACKNOWLEDGE THAT VNSNY CHOICE IS NOT LIABLE FOR THE DEFAMATORY, OFFENSIVE OR ILLEGAL CONDUCT OF OTHER USERS OR THIRD PARTIES AND THAT THE RISK OF INJURY FROM THE FOREGOING RESTS ENTIRELY WITH YOU.<\/em><\/p>\n<p><em>IN NO EVENT WILL VNSNY CHOICE, THE VNSNY CHOICE PARTIES, OR ANY PERSON OR ENTITY INVOLVED IN CREATING OR PRODUCING OR DISTRIBUTING THE SITE BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL OR PUNITIVE DAMAGES ARISING OUT OF THE USE OF OR INABILITY TO USE THE SITE. YOU HEREBY ACKNOWLEDGE THAT THE PROVISIONS OF THIS SECTION SHALL APPLY TO ALL CONTENT ON THE SITE.<\/em><\/p>\n<p><em>IN ADDITION TO THE TERMS SET FORTH ABOVE, NEITHER VNSNY CHOICE NOR THE VNSNY CHOICE PARTIES SHALL BE LIABLE, REGARDLESS OF THE CAUSE OF DURATION FOR ANY ERRORS, INACCURACIES, OMISSIONS, OR OTHER DEFECTS IN, OR UNTIMELINESS, OR INAUTHENTICITY OF THE INFORMATION CONTAINED WITHIN THE SITE OR FOR ANY DELAY OR INTERRUPTION IN THE TRANSMISSION THEREOF TO YOU, OR FOR ANY CLAIMS OR LOSSES ARISING THEREFROM OR OCCASIONED THEREBY. NONE OF THE FOREGOING PARTIES SHALL BE LIABLE FOR ANY THIRD-PARTY CLAIMS OR LOSSES OF ANY NATURE, INCLUDING, BUT NOT LIMITED TO, LOST PROFITS, PUNITIVE OR CONSEQUENTIAL DAMAGES AND THE AGGREGATE, TOTAL LIABILITY OF THE VNSNY CHOICE PARTIES TO YOU OR ANY END USER FOR ALL DAMAGES, INJURY, LOSSES AND CAUSES OF ACTION (WHETHER IN CONTRACT, TORT OR OTHERWISE) ARISING FROM OR RELATING TO THIS AGREEMENT OR THE USE OF OR INABILITY TO USE THIS SITE SHALL BE LIMITED TO PROVEN DIRECT DAMAGES IN AN AMOUNT NOT TO EXCEED ONE HUNDRED DOLLARS ($100). \u00a0 \u00a0<\/em><\/p>\n<p><em>SOME JURISDICTIONS DO NOT ALLOW THE LIMITATION OR EXCLUSION OF CERTAIN LIABILITIES OR WARRANTIES, SO SOME OF THE ABOVE LIMITATIONS MAY NOT APPLY TO YOU.\u00a0<\/em>In such jurisdictions, VNSNY CHOICE's liability is limited to the greatest extent permitted by the law. You should check your local laws for any restrictions or limitations regarding the exclusion of implied warranties.<\/p>\n\n<h3><strong>INDEMNIFICATION\u00a0<\/strong><\/h3>\n<p>By accessing and\/or using the Site, you agree to indemnify, defend and hold VNSNY CHOICE, our subsidiaries and affiliates, and their respective officers, directors, employees, members, agents, representatives, business partners, information providers, licensors and licensees and their respective heirs and assigns (collectively the \"Indemnified Parties\") harmless from and against any and all liability costs, including, without limitation, reasonable attorney's fees and expenses incurred by the Indemnified Parties in connection with any claim arising out or, or breach by you of, these Terms of Use, any related license terms, or by any unauthorized use by you of this Site. You agree to cooperate as fully as reasonably required in the defense of any claim. We reserve the right, at our own expense, to assume the exclusive defense and control of any matter otherwise subject to indemnification by you. You shall not enter into any settlement agreement that affects the rights of any of the Indemnified Parties or requires the taking of any action by any of them, without our prior written approval.<\/p>\n\n<h3>PRIVACY<\/h3>\n<p>Personal information you provide to us is subject to our Privacy Policy, as updated from time to time, which is incorporated by reference into these Terms of Use and is available at\u00a0<a href=\"http:\/\/www.vnsnychoice.org\/\">www.vnsnychoice.org<\/a>.<\/p>\n\n<h3>MISCELLANEOUS<\/h3>\n<p>These Terms of Use, and any rights and licenses hereunder, may not be transferred or assigned by you, but may be assigned by VNSNY CHOICE without restriction.<\/p>\n<p>You agree that, except as expressly provided in these Terms of Use (and other than VNSNY CHOICE and its affiliates), there shall be no third-party beneficiaries of these Terms of Use.<\/p>\n<p>You agree that: (i) the VNSNY CHOICE Site shall be deemed solely based in New York, New York; and (ii) the VNSNY CHOICE Site shall be deemed a passive website that does not give rise to personal jurisdiction over VNSNY CHOICE, either specific or general, in jurisdictions other than New York. These Terms of Use shall be governed by the substantive internal laws of the State of New York, without respect to its conflict of law principals. Any claim or dispute that arises between you and VNSNY CHOICE that arises in whole or in part from the VNSNY CHOICE Site shall be decided exclusively by a court of competent jurisdiction located in New York, New York. These Terms of Use, together with the Privacy Policy, the Code of Conduct, and any other legal notices published by VNSNY CHOICE on the Site, shall constitute the entire agreement between you and VNSNY CHOICE concerning the VNSNY CHOICE Site. If any provision of these Terms of Use is deemed invalid by a court of competent jurisdiction, the invalidity of such provision shall not affect the validity of the remaining provisions of these Terms of Use, which shall remain in full force and effect. No waiver of any of these Terms of Use shall be deemed a further or continuing waiver of such term or any other term, and VNSNY CHOICE's failure to assert any right or provision under these Terms of Use shall not constitute a waiver of such right or provision.<\/p>\n<p><em>YOU AND VNSNY CHOICE AGREE THAT ANY CAUSE OF ACTION ARISING OUT OF OR RELATED TO THE VNSNY CHOICE SITE MUST COMMENCE WITHIN ONE (1) YEAR AFTER THE CAUSE OF ACTION ACCRUES. OTHERWISE, SUCH ACTION IS PERMANENTLY BARRED.\u00a0<\/em><\/p>\n<p>It is our and your intent that these Terms of Use constitute a binding and enforceable agreement between us. Therefore, you affirm that you are at least 18 years of age and are fully able and competent to enter into the terms, conditions, obligations, affirmations, representations and warranties set forth in these Terms of Use, and to abide by and comply with these Terms of Use.<\/p>\n\n<h3><strong>MODIFICATIONS TO THESE TERMS OF USE<\/strong><\/h3>\n<p>VNSNY CHOICE reserves the right to amend these Terms of Use at any time and without prior notice, and it is your responsibility to review these Terms of Use for any changes. Your use of the VNSNY CHOICE Site following any amendment of these Terms of Use, which will be reflected by the \"Last Updated\" date at the bottom, will signify your assent to and acceptance of the revised terms.<\/p>\n\n<h3><strong>QUESTIONS<\/strong><\/h3>\n<p>If you have any questions about these Terms of Use, you may contact us at\u00a0<a href=\"tel:1-855-282-4642\">1-855-282-4642.<\/a><\/p>",
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