NYSDOH Plan Participation Audit Starts Soon – Review Your Network Participation Now
Date Issued: 5/4/2016
On behalf of the New York State Department of Health (NYSDOH), the Island Peer Review Organization (IPRO) may contact you shortly to verify your directory information and participation in our networks. This audit is conducted on a yearly basis and includes Primary Care and Obstetrics and Gynecology practitioners.
The following networks* are included in the IPRO audit:
- Prime Network (includes CHPlus)
- Enhanced Care Prime Network (includes Medicaid/ HARP and Essential Plan (BHP)
* You are responsible for knowing the networks your practice participates with. You may or may not participate with each of the Networks listed above.
Prepare your office for the NYSDOH call.
To confirm the accuracy of your information in our online directory, please verify that the practice details under each plan are correct on our website, particularly your telephone number, practice locations, provider specialty and hospital affiliations.
Ensure your staff is familiar with the networks you participate in.
Once you have confirmed the accuracy of your practice information make sure each staff member that answers the phone has fast access to a list of the Networks with which your practice participates.
Auditors may refer to these Networks as follows:
- EmblemHealth’s HIP Prime Network or EmblemHealth’s HIP Medicaid Prime Network or
EmblemHealth’s HIP MA benefit plan or the EmblemHealth Medicaid Managed Care (MMC)
Child Health Plus:
- EmblemHealth’s HIP Prime Network or EmblemHealth’s HIP CHPlus Prime Network or
EmblemHealth’s HIP Child Health Plus Prime Network or EmblemHealth’s HIP Kid benefit plan
- EmblemHealth’s HIP Prime Network
Update your information.
You may enter updates to practice information on the Provider/Practice Profile screen or fax your changes to our Provider Modifications team at 1-877-889-9061. Be sure to notify us when a provider leaves your practice. You can also mail your changes to:
Provider Modifications Team, 55 Water Street, 6th Floor, New York, NY, 10041-8190.
IPRO verification audits are important to you EmblemHealth and the NYSDOH.
In addition to verifying that your patients — our members — have appropriate access to covered care and services, the outcome of the survey impacts NYSDOH's ability to obtain Centers for Medicare & Medicaid approval to implement planned Medicaid Redesign Team benefit and population changes. We value your participation with us and appreciate your attention to this request.