Our providers know that everything from rules and regulations to best practices and cutting-edge innovations are always evolving across the healthcare landscape.
From timely reminders about combating antibiotic resistance to updates on Medicaid, Medicare, and more, our news service gives our providers the up-to-date information they need to deliver the best care possible.
Important & Urgent Notifications
July 29, 2025
REMINDER: Mobile Crisis and Crisis Residence Benefit and Billing Guidance – Language Interpreter Services
June 10, 2025
RE: Updated Billing Changes to the Telehealth Audio-Only Modifier Use for OMH-Licensed/Designated Outpatient Programs Grid and Audio-Only Modifier Change
June 10, 2025
Lab Reimbursement Policy
June 06, 2025
29-I Health Facility Billing Manual Update – Procedure Code 98016
May 07, 2025
Availity Eligibility and Claim Inquiry Update
April 29, 2025
RE: HEALTH HOMES ADDED TO ELIGIBLE PROVIDERS FOR COMMUNITY HEALTH WORKERS
April 17, 2025
RE: TELEHEALTH – CHANGES TO AUDIO-ONLY BILLING
April 11, 2025
RE: eConsults Expansion
April 08, 2025
RE: SBHC COVERED SERVICES – DELAYED
29 Jul
REMINDER: Mobile Crisis and Crisis Residence Benefit and Billing Guidance – Language Interpreter Services
IMPACTED PLANS: Medicaid, SNP, HARP, MAP and Child Health Plus Dear MetroPlusHealth Provider, OMH has combined the previous issued guidance…
10 Jun
RE: Updated Billing Changes to the Telehealth Audio-Only Modifier Use for OMH-Licensed/Designated Outpatient Programs Grid and Audio-Only Modifier Change
IMPACTED PLANS: Medicaid, HIV SNP, HARP, and MAP Dear MetroPlusHealth Provider, Effective July 1, 2025, OMH providers should use modifier…
10 Jun
Lab Reimbursement Policy
Dear Valued Provider, MetroPlusHealth is committed to keeping our provider network informed of important policies. This notice serves as a…
06 Jun
29-I Health Facility Billing Manual Update – Procedure Code 98016
IMPACTED PLANS: MEDICAID and HIV SNP Dear MetroPlusHealth Provider, Effective as of January 1, 2025, the Office of Mental Health…
07 May
Availity Eligibility and Claim Inquiry Update
MetroPlusHealth is continuing to offer additional resources to meet the needs of our provider network. We are expanding our partnership…
29 Apr
RE: HEALTH HOMES ADDED TO ELIGIBLE PROVIDERS FOR COMMUNITY HEALTH WORKERS
TO: ALL PROVIDERS Dear MetroPlusHealth Provider, Effective April 1, 2025, the New York State Department of Health has released notice…
17 Apr
RE: TELEHEALTH – CHANGES TO AUDIO-ONLY BILLING
TO: ALL PROVIDERS As of January 1, 2025, per New York State Medicaid updated guidance, the American Medical Association (AMA)…
11 Apr
RE: eConsults Expansion
TO: All MetroPlusHealth Providers Effective as of March 1, 2025, MetroPlusHealth will reimburse eConsult services for Hospital Outpatient Departments (OPDs),…
08 Apr
RE: SBHC COVERED SERVICES – DELAYED
Previously, DOH released an anticipated carve in date of May 1, 2025, for School-Based Health Center services (SBHCs) to be…
01 Apr
URGENT MESSAGE FOR YOUR PATIENTS AND THEIR PAID CAREGIVERS
Your patients who participate in the Consumer Directed Personal Assistance Program (CDPAP), and/or their personal assistant(s), must take IMMEDIATE ACTION…
01 Apr
RE: New Medicare Behavioral Health Utilization Management (BHUM) and ABA Fax Line
TO: All Behavioral Health Providers Effective April 1, 2025, MetroPlusHealth will have a new Medicare BHUM fax number, below: BHUM…
19 Mar
RE: Doula Services IMPACTED PLANS: Medicaid, HIV SNP, HARP and EP
TO: MetroPlusHealth Doula and OB/GYN Providers RE: Doula Services IMPACTED PLANS: Medicaid, HIV SNP, HARP and EP Dear MetroPlusHealth Provider,…
14 Mar
URGENT MESSAGE FOR YOUR PATIENTS AND THEIR PAID CAREGIVERS REGARDING CDPAP CHANGE
Your patients who participate in the Consumer Directed Personal Assistance Program (CDPAP), and/or their personal assistant(s), must take IMMEDIATE ACTION…
12 Mar
RE: COVERAGE OF HYPOGLOSSAL NERVE STIMULATORS
TO: MEDICAID MANAGED CARE PROVIDERS Dear MetroPlus Health Provider, Effective March 1, 2025, per New York State (NYS) Medicaid guidance,…
10 Mar
RE: Important Message from the Managed Long-Term Care Department to Providers Servicing Members with Medicaid and Medicare Coverage Receiving:
Personal Care Services (PCS) Consumer-Directed Personal Assistance Services (CDPAS) Dear MetroPlusHealth Provider, Effective April 7, 2025, MetroPlusHealth will start directing…
05 Mar
RE: Status Update of Extension of Implementation of NYS OASAS COP Rate Codes
TO: OASAS Comprehensive Outpatient Program (COP) Providers Dear MetroPlusHealth Provider, The New York State Office of Addiction Services and Supports…
28 Feb
RE: HOME SLEEP TEST
TO: MEDICAID MANAGED CARE PROVIDERS Effective December 1, 2024 onwards, per New York State (NYS) Medicaid guidance, MetroPlusHealth will begin…
26 Feb
RE: All Personalized Recovery Oriented Services (PROS) Providers
In July 2024, NYS submitted the proposed State Plan Amendment (SPA) #23-0098 to the Center for Medicaid and Medicare Services…
11 Feb
MetroPlusHealth’s Partnership with BetterDoctor: FAQ
1. What is BetterDoctor? BetterDoctor, a division of Quest Analytics®, provides reliable provider network and verification services. By using the…
11 Feb
MetroPlusHealth is proud to announce our 2025 Provider Pay for Performance (P4P) program
This program rewards providers who meet specific goals for delivering quality and efficient care goals to MetroPlusHealth members enrolled in…
05 Feb
COVERAGE AND REIMBURSEMENT OF EVISITS
TO: MEDICAID PROVIDERS (Retro) Effective October 1st, 2023, per New York State (NYS) Medicaid guidance update, MetroPlusHealth is allowing reimbursement…
04 Feb
Removal of Primary Care Provider (PCP) Name on ID Card
Starting November 1, 2024, MetroPlusHealth member ID cards for newly enrolled members or reissued member cards, will no longer reflect…
24 Jan
Expanded Reimbursement To Population For Adverse Childhood Experiences Screening
IMPACTED PLANS: MAINSTREAM MEDICAID, HIV SNP, and HARP Dear MetroPlusHealth Provider: Effective January 1, 2025, per updated mandate issued by…
24 Jan
Health Homes Serving Children Providers
IMPACTED PLANS: Medicaid and HIV SNP Effective October 1, 2024, the New York State Department of Health (NYSDOH) has received…
15 Jan
Self-administered Hormonal Contraception Medication Without a Prescription
Effective January 1, 2024, Governor Kathy Hochul authorized New York State pharmacists to dispense three types of self-administered hormonal contraception…
Provider Support
last updated: June 3, 2024
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