INFORMATION FOR ALL PROVIDERS MANAGED CARE …
Information for All Providers ? Managed Care Information
NEW YORK STATE MEDICAID PROGRAM
INFORMATION FOR ALL PROVIDERS MANAGED CARE INFORMATION
Information for All Providers ? Managed Care Information
Table of Contents
PREPAID CAPITATION PLANS (PCP) ...................................................................................................................3 COUNTY/DISTRICT CODES......................................................................................................................................7
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Information for All Providers ? Managed Care Information
Prepaid Capitation Plans (PCP)
Key:
Plan Type Abbreviation Partial LTC LTC Pace Medicaid Adv Plus FHP SNP Mainstream Medicaid Advantage FIDA IDD
HARP
descri ptio n
Model Contract Link
Long Term Care: Partial Capitation
ial_capit atio n_model.pdf
Long Term Care: PACE
e_model_co nt ract .pdf
Long Term Care: Medicaid Advantage
Plus
dic aid_adv _plus_model_co ntract .pdf
Family Health Plus
naged_c are_f hp_hiv -s np_model_co ntract.pdf
Special Needs Plan
naged_c are_f hp_hiv -s np_model_co ntract.pdf
Medical Assistance
naged_c are_f hp_hiv -s np_model_co ntract.pdf
Medicaid Advantage
dic aid_adv ant age_model_co ntract .pdf
Fully Integrated Duals Advantage Plan ?
Intellectual and Developmental Disabilities _management/FIDA_IDD
Health and Recovery Plan
naged_c are_f hp_hiv -s np_model_co ntract.pdf
Plan Code 82 92 AA AC
AF AG
AH
AP
AZ
C2 C7
CC
CD CG
Plan ID# 00477156 00894519 04004537 03114514
04342307 03481927
03458546
03466800
05572692
01249265 01234037
03320725
04342316 01183013
PCP Provider Name Affinity Health Plan, Inc. Metroplus Health Plan, Inc. Healthplus HP LLC Catholic MLTC - ArchCare Senior Life
Affinity Health Plan ? Enriched Plan AgeWell New York, LLC
Aetna Better Health
Archcare-Catholic Managed LTCS MLTC AgeWell NY LLC MAP
HealthNow NY, Inc. (Community Blue) CenterLight HealthCare
Complete Senior Care
Capital District Physician's Health Plan Capital District Physician's Health Plan
Telephone Number (800) 553-8247 (800) 597-3380 (800) 454-3730 (866) 263-9083 TTY (800) 662-1220
(800) 553-8247 (866) 586-8044 TTY (800) 662-1200
(855) 456-9126 TTY (711)
(866) 467-9351 TTY (711)
(866)237-3210 TTY (800) 662-1200
(716) 887-6900 (877) 226-8500 TTY (800) 650-2774
(888)303-4333 TTY (716) 285-8248
(518) 641-3500 (800) 926-7626
Plan Type Mainstream Mainstream HARP LTC Pace
HARP Partial LTC
Partial LTC
Partial LTC
Medicaid Adv Plus Mainstream LTC Pace
LTC Pace
HARP Mainstream
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Information for All Providers ? Managed Care Information
Plan Code Plan ID# PCP Provider Name
CH
03072740 Catholic Health Life PACE
CP
03506989 Centers Plan for Healthy Living
CM
05357520 Centers Plan for Medicaid Advantage
Plus
EA
05410146 Elderserve Health MAP, INC
E7
01674982 Senior Care Connection (the Eddy)
EC
03549135 Extended MLTC LLC
ED
03253707 Elderplan, Inc dba Homefirst
EE
04342343 Excellus ? Blue Option Plus - HARP
EG
03690851 KALOS Health
EH
03234044 RiverSpring at Home (Elderserve)
FZ
04190745 Fallon Health Weinberg PACE
GD
01788325 Fidelis Care at Home
HA
06259723 Hamaspik MAP INC
H1
02104369 Senior Health Partners, Inc.
HC
03522947 Hamaspik Choice
HF HI HT,98,99 HW HY IC
IE
04003696 Healthfirst PHSP Person Wellness Plan 04082293 HIP of Greater NY 00313979 HIP of Greater NY 01131584 HIP Westchester 01202822 HIP Nassau 03866960 iCircle Service of the Finger Lakes
01208997 Independent Health Association
Telephone Number
(855) 671-3341 TTY (716) 819-5084
(855) 270-1600 TTY (800) 421-1220
(833)-274-5627 TTY: 1800 421 1220
1-800-580-7000 TTY/TDD: 711 (855) 376-7888 TTY (800) 662-1220
(866) 389-2656 (855) 899-6492
(866) 389-2656 TTY (800) 662-1220
(800) 894-2464 TTY (800) 662-1220
(800) 370-3600 TTY (866) 236-5800
(855) 665-1113 (TTY 711)
(888) 343-3547 TTY (800) 695-8544
(855) 552-4642 TTY/TDD: (855) 8544030 (866) 585-9280 TTY (800) 662-1220
(855) 552-4642 TTY (877) 544-6220
(866) 463-6743
(646) 447-5000
(646) 447-5000
(646) 447-5000
(646) 447-5000
(844) 424-7253 TTY (711) (800) 736-5771
Plan Type LTC Pace
Partial LTC
Medicaid Adv Plus Medicaid Adv Plus LTC Pace
Partial LTC
Partial LTC
HARP Partial LTC
Partial LTC
LTC PACE
Partial LTC
Medicaid Adv Plus Partial LTC
Partial LTC
HARP HARP Mainstream Mainstream Mainstream Partial LTC Mainstream
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Information for All Providers ? Managed Care Information
Plan Code IH
IL
IP
IS
IT
KP KX
M3
MA
MF
MH
MO MP
MR MT MV MZ
N6
NA
NC OD OM PC
PO
SF SP SP
Plan ID# 04342325
01278899
05922454
PCP Provider Name
Independent Health's MediSource Connect - HARP Elder One (Independent Living for Seniors) Integra MAP
01519162 PACE CNY (Loretto HMO)
03475427 Integra MLTC, Inc
01617894 02644562
01825947
Healthplus HP, LLC
Amerigroup Community Connections (Empire BC/BS Amerigroup Health Plus) Evercare Choice, Inc. (Elant Choice)
04342334 MVP Harmonious Health Care Plan HARP
03594052 Montefiore HMO
03420808
01403176 03466906
HealthFirst Complete Care (Managed Health, Inc. MAP) United HealthCare of NY, Inc.
MetroPlus MLTC
00477023 04053201 01111375
01778523
Excellus Metroplus Health Plan Inc. MVP, Inc.
Senior Network Health, LLC
02188296
04122776
04004486 02191582 02191362 03581413
Total Aging in Place (Fallon Health Weinberg) Niagara Advantage Health Plan LLC (d/b/a Elderwood) HealthierLife
Amida Care Inc., (VidaCare, Inc., SN) Metroplus Partnership Care SN Prime Health Choice
04099212 Partners Health Plan ? FIDA IDD
01479670 01421250 01751046
HealthFirst PHSP, Inc. Fidelis Care New York Fidelis Care New York
Telephone Number
(855) 457-4636 TTY (800) 662-1220 (877) 388-5195
(888) 728-7223 TTY (800) 662-1220 (855) 661-0002 TTY (711) (800) 454-3730 (866) 805-4589 TTY (800) 855-2880
(877) 255-3678 (845) 569-2228
(855) 556-6683 TTY (711) (888) 260-1010 TTY (888) 542-3821 (877) 842-3210 (855) 355-6582 TTY (800) 881-2812 (800) 920-8889 (800) 597-3380 (800) 684-9286
(888) 355-4764 TTY (800) 662-1220 (716) 250-3100 (866) 882-8185 (866) 843-7526 TTY (711) (800) 749-0820
(646) 786-1800 (800) 303-9626 (855) 777-4630 TTY (855) 777-4613 (855) 747-5483 TTY (711) (866) 463-6743 (800) 749-0820 (800) 749-0820
Plan Type HARP
LTC Pace
Medicaid Adv Plus LTC Pace
Partial LTC
Mainstream Partial LTC
Partial LTC
HARP
Partial LTC
Medicaid Adv Plus Mainstream Partial LTC
Mainstream HARP Mainstream Partial LTC
Partial LTC
Partial LTC
HARP SNP SNP Partial LTC
FIDA-IDD
Mainstream Mainstream Mainstream
Version 2021-1
March 8, 2021
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