Manuals and Forms

Click to download provider manuals, tip sheets, important forms, and applications. 

Provider Manuals




APPENDICES - Provider Manual

Appendix I: Authorization Grids

Appendix II: Pharmacy Services

Appendix III: Coverage of Vaccines for Medicaid and child Health Plus Members (revised) (PDF)

    Coverage of Vaccines for Medicaid and Child Health Plus Members (PDF)

    Coverage of Vaccines for Metal-Level Product and Essential Plan Members (PDF)

Appendix IV: Cage A Instrument (PDF)

Appendix V:  Depression Screen: Patient Health Questionnaire (PHQ-9) and Scoring Instructions for PHQ-9

Appendix VI: HIV Names Reporting and Partner Notification Regulations

Appendix VII: New York State Child/Teen Health Program (PDF)

Appendix VIII: Prenatal Guidelines (PDF)

Appendix IX: Provider's Guide to Public Health Issues (PDF)

Appendix X: Medicaid Member Handbook (PDF)

Appendix XI: Retired

Appendix XII: Child Health Plus Member Handbook (PDF)

Appendix XIII: Sample Member ID Cards (PDF)

Appendix XIV: Guide to Billing for Obstetrical Providers (PDF)

Appendix XV: Bill Above List (PDF)

Appendix XVI: Special Needs Plan (PDF)

Appendix XVII: Special Needs Model of Care Training (PDF)

Appendix XVIII: FIDA Grievances and Appeals (PDF)

Appendix XIX: Cultural Sensitivity and ADA (PDF)

Appendix XX: Continuity of Care Responsibilities (PDF)

Appendix XXI: Columbia Suicide Severity Rating Scale (PDF)

Appendix XXII: Generalized Anxiety Disorder 7 Item GAD 7 Scale (PDF)


APPENDICES - Qualified Health Plans/Essential Plan Provider Manual

Appendix I: Authorization Grids

Appendix II: Pharmacy Services

Appendix III: Coverage of Vaccines for Medicaid and child Health Plus Members (revised) (PDF)

    Coverage of Vaccines for Medicaid and Child Health Plus Members (PDF)

    Coverage of Vaccines for Metal-Level Product and Essential Plan Members (PDF)

Appendix IV: Cage A Instrument (PDF)

Appendix V:  Depression Screen: Patient Health Questionnaire (PHQ-9) and Scoring Instructions for PHQ-9

Appendix VI: HIV Names Reporting and Partner Notification Regulations

Appendix VII: New York State Child/Teen Health Program (PDF)

Appendix VIII: Provider's Guide to Public Health Issues (PDF)

Appendix IX:  Sample Member ID Cards (PDF)

Appendix X: Columbia Suicide Severity Rating Scale (PDF)

Appendix XI: Generalized Anxiety Disorder 7 Item GAD 7 Scale (PDF)

Provider Tip Sheets

Products

Access and Availability Standards Tip Sheet (PDF)

Essential Plan Tip Sheet (PDF)

FIDA Tip Sheet (PDF)

Medicaid and CHP Provider Tip Sheet (PDF)

Medicaid and HealthierLife: Behavioral Health (BH) Carve-in and Health and Recovery Plan (HARP) HCBS Claims Tip Sheet (PDF)

Medicare Advantage & Dual Advantage Tip Sheet (PDF)

Metal-Level Products Tip Sheet (PDF)

MLTC Tip Sheet (PDF)


Quality

Behavioral Health Case Management Services Tip Sheet (PDF)

Importance of Chlamydia Screening Tip Sheet (PDF)

Quality PCP Tip Sheet (PDF)

Viral Load Suppression Tip Sheet (PDF)


Provider User Guides

EDI Provider Tip Sheet (PDF)

eviCore Program Tip Sheet (PDF)

Interactive Voice Response Application for Checking Claim Status Tip Sheet (PDF)

Provider Portal User Guide - Online Authorizations Tip Sheet (PDF)

Request for Authorization Fax Lines Reference Tool Tip Sheet (PDF)


Other Services

Adult Day Health Care Provider Tip Sheet (PDF)

AIDS Adult Day Health Care Provider Tip Sheet (PDF)

Consumer Direct Personal Assistance Services Tip Sheet (PDF)

Hospice Services Tip Sheet (PDF)

Nursing Home Tip Sheet (PDF)

Personal Care Services (PCS) Tip Sheet (PDF)

Servicing the Homeless Tip Sheet (PDF)

Transportation Services (Non-Emergency) - Livery-Taxi/Ambulette/Ambulance Tip Sheet (PDF)

Transportation Services (Non-Emergency) - Out of County Approval Request Tip Sheet (PDF)


Provider Access Online

Verify member eligibility, check claims status, and more.

Pharmacy Services

Formularies, utilization management programs, general pharmacy updates, and specialty drug programs. 

Authorization Grids

Authorization Grids for Medicare, Medicaid, Child Health Plus, and NY State of Health Marketplace plans.