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Provider Resources

Important provider resources, forms and guidelines for providers in the Partners Health Plan network.

Billing & Claims

Claims and billing submission guidelines, contact information, and other billing and claims resources

Authorizations & Appeals

Authorization requirements, request forms, and appeal / greivance information.

Durable Medical Equipment (DME)

DMEPOS Requests, Requirements and Resources

FAQ & Reference Guide

Important contact information and frequently asked questions.

2023 Provider Manual

Provider Events & Webinars

Previous Provider Webinars

August 22, 2023 Provider Webinar: Medicaid Eligibility: Maintaining Benefits for the Intellectually and Developmentally Disabled in New York State

This webinar was in collaboration with Care Design NY and focused onchanges to Medicaid eligibility and recertifications, as well as the unwinding of the Public Health Emergency (PHE) as it relates to Medicaid coverage.

PRESENTED BY: Kristina Cunningham, Assistant Vice President of Member Benefits and Enrollment

Supporting Documents:

Webinar Slides | Qualifying Expenses - Spenddowns | 2023 Spenddown Calculation Example | 2023 SSI and Personal Allowance Amounts | 2023 Federal Poverty Level Guidelines

June 14, 2023 Provider Webinar: Medication Related Risk in the IDD Population

This webinar was in collaboration with Care Design NY and focused on: 

  • Medication Risks for the IDD Population
  • PHP’s clinical pharmacy program
  • Comprehensive Medication Therapy Reviews (CMTRs)
  • What is a CMTR and how it is used
  • Clinical Pharmacy program outcomes

PRESENTED BY: Scott Doolan RN BSN, MBA, Assistant Vice President of Health Care Management

Webinar Slides

March 22, 2023 Provider Webinar:
What is IDD Care Management and What Does It Mean To Me?

This webinar was in collaboration with Care Design NY and focused on how Care Management is different when in support of someone with an Intellectual or Developmental Disability (IDD) and the importance of collaboration between IDD Care Managers and the provider community.

PRESENTED BY: Steven Merahn, MD, Medical Director

Webinar Slides

February 24, 2022 Provider Webinar
in Collaboration with Care Design NY: The Life Plan Process

This webinar reviewed the CDNY & PHP alignment, the Life Plan process, the CDNY and PHP escalation process, and how to ensure effective communication and timely resolution.

Webinar Slides

Webinar Q&A

October, 26, 2021 Provider Webinar:
Important Billing and Claims Updates and Reminders

This webinar reviewed Partners Health Plan’s Care Management model, the Life Plan, and important billing and claims reminders, how to appeal a claim denial and timely filing guidelines.

Webinar Slides

Webinar Q&A

Provider News, Updates & Announcements

Stay up-to-date on important information for providers in the PHP Provider Network.

National Enteral Supply Shortage

13 September 2023
National Enteral Supply Shortage Attention Providers who Prescribe Enteral Supplies or Support M...

Message from the Medical Director: COVID-19 Update

28 August 2023
Message from the Medical Director An Update on COVID-19 Dear Members, Families, and Friends, Over...

8.23.23 UPDATE: ARPA Workforce Stabilization Payment Initiative

23 August 2023
August 23, 2023 Dear Provider: Partners Health Plan (PHP) wants to provide you with an update...

Are you looking for a direct channel to useful state resources
relevant to participation in Medicaid and other health programs?

Visit the NYS Department of Health Provider Page

Need Provider Assistance?

The Partners Health Plan Network Development and Provider Relations team is here to assist you with your billing, claims, authorization, education, and any other general inquiry. Use the Contact Us button below to complete a Provider Ticket Submission Form.