Provider Materials

At Senior Whole Health of New York, we value you as a provider in our network. That’s why we work hard to provide you with the resources you need to help care for our members.

Looking for Senior Whole Health of New York MLTC provider materials? Follow this link

Provider Information

Provider Manual

Sample Remittance Advice

Reference Guide to High Risk Medications & their Alternatives

Quality of Insider – Model of Care Summary

PCP Behavioral Health Toolkit (available through Beacon Health)

SWH Dental Provider Manual (available through SKYGEN USA’s Provider Portal)

 

Compliance

FDR Compliance Guide

Magellan False Claims Act Policy

Magellan HIPAA Compliance Statement

Fraud Waste and Abuse Reporting Policy

 

Helpful Resources

Case Trakker Access Request Form

Claims Submission Guideline

Corrected Claims Submission Guideline

Importance of Updating Provider Data

Provider Referral Form

Provider Certificate of Medical Necessity (Oxygen) Form

Telehealth HEDIS Codes Reference Guide

Provider Sun Safety Reminder Flyer

 

Pharmacy & Prescription Drug Materials

2021 Formulary (September 2021)

Part D Formulary Change Chart (September 2021)

Prior Authorization Drug List (September 2021)

List of Pharmacy Drugs (J-Code) Requiring Prior Authorization (updated May 2021)

 

Frequently Used Forms

Online Request for Medicare Part D Redetermination

Online Request for Medicare Part D Prescription Drug Coverage

Prescription Coverage Determination Form

Medicare Reconsideration Request Form

Medicare Redetermination Request Form

Information regarding Coronavirus (COVID-19)

COVID-19 Vaccine Provider FAQ

COVID-19 Telehealth Provider Q&A

HEDIS® Telehealth Accepted Codes

Guidance on Suspended Health Plan Utilization Review Requirements
The New York State Department of Health (NYSDOH) has provided guidance on suspension of health plan utilization review requirements for inpatient rehabilitation facilities, skilled nursing facilities and other health care providers.

NYDSOH Guidance on Suspended Health Plan Utilization Review Requirements

Cost Sharing Waiver
The New York State Department of Financial Services (DFS), the New York State Department of Health, and the federal government are directing payers to waive patient copays, coinsurance and deductibles for certain testing and treatment due to the COVID-19 emergency.

Cost Sharing Waiver

New York State Coronavirus 1135 Waiver
New York State was granted a Medicaid 1135 waiver from CMS on March 26, 2020. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the CMS Current Emergencies WebsiteMS Current Emergencies Website.

NY Medicaid 1135 Waiver

Webinars:

How to build resilience and adaptive skills during the pandemic Tips for caring for the emotional health and wellness of you and your family during these uncertain times. Learn more. If you missed the live webinar, the recording is posted here.

Recent Provider Bulletins
HEDIS® Tip Sheets