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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Prepaid Capitation Plans (PCP)

Key:
Plan Type Abbreviation description Model Contract Link
Partial LTC Long Term Care: Partial Capitation http://www.health.ny.gov/health_care/medicaid/redesign/docs/mrt90_part
ial_capitation_model.pdf
LTC Pace Long Term Care: PACE http://www.health.ny.gov/health_care/medicaid/redesign/docs/mrt90_pac
e_model_contract.pdf
Medicaid Adv Plus Long Term Care: Medicaid Advantage http://www.health.ny.gov/health_care/medicaid/redesign/docs/mrt90_me
Plus dicaid_adv_plus_model_contract.pdf
FHP Family Health Plus http://www.health.ny.gov/health_care/managed_care/docs/medicaid_ma
naged_care_fhp_hiv-snp_model_contract.pdf
SNP Special Needs Plan http://www.health.ny.gov/health_care/managed_care/docs/medicaid_ma
naged_care_fhp_hiv-snp_model_contract.pdf
Mainstream Medical Assistance http://www.health.ny.gov/health_care/managed_care/docs/medicaid_ma
naged_care_fhp_hiv-snp_model_contract.pdf
Medicaid Advantage Medicaid Advantage http://www.health.ny.gov/health_care/medicaid/redesign/docs/mrt90_me
dicaid_advantage_model_contract.pdf
FIDA IDD Fully Integrated Duals Advantage Plan – https://opwdd.ny.gov/opwdd_services_supports/people_first_waiver/care
Intellectual and Developmental Disabilities _management/FIDA_IDD

HARP Health and Recovery Plan http://www.health.ny.gov/health_care/managed_care/docs/medicaid_ma

naged_care_fhp_hiv-snp_model_contract.pdf

Plan Code Plan ID# PCP Provider Name Telephone Number Plan Type
82 00477156 Affinity Health Plan, Inc. (800) 553-8247 Mainstream
92 00894519 Metroplus Health Plan, Inc. (800) 597-3380 Mainstream
AA 04004537 Healthplus HP LLC (800) 454-3730 HARP
AC 03114514 ArchCare Senior Life (Catholic (866) 263-9083 LTC Pace
Managed Long Term Care Inc) TTY (800) 662-1220
AF 04342307 Affinity Health Plan – Enriched Plan (800) 553-8247 HARP
AG 03481927 AgeWell New York, LLC (866) 586-8044 Partial LTC
TTY (800) 662-1200
AH 03458546 Aetna Better Health (855) 456-9126 Partial LTC
TTY (711)
AP 03466800 Archcare Community Life (866) 467-9351 Partial LTC
(Catholic Managed LTCS MLTC) TTY (711)
AZ 05572692 AgeWell MAP (866)237-3210 Medicaid Adv
(Age Well New York MAP LLC) TTY (800) 662-1200 Plus
C2 01249265 HealthNow NY, Inc. (Community Blue) (716) 887-6900 Mainstream
C7 01234037 CenterLight HealthCare PACE (877) 226-8500 LTC Pace
TTY (800) 650-2774
CC 03320725 Complete Senior Care Inc (888)303-4333 LTC Pace
TTY (716) 285-8248
CD 04342316 Capital District Physician’s Health Plan HARP
CG 01183013 Capital District Physician’s Health Plan (518) 641-3500 Mainstream
(800) 926-7626

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Plan Code Plan ID# PCP Provider Name Telephone Number Plan Type
CH 03072740 Catholic Health Life PACE (855) 671-3341 LTC Pace
TTY (716) 819-5084
CP 03506989 Centers Plan for Healthy Living (855) 270-1600 Partial LTC
TTY (800) 421-1220
CM 05357520 Centers Plan for Medicaid Advantage (833)-274-5627 Medicaid Adv
Plus TTY: 1800 421 1220 Plus
EA 05410146 Elderserve Health MAP, INC 1-800-580-7000 Medicaid Adv
TTY/TDD: 711 Plus
E7 01674982 Senior Care Connection (855) 376-7888 LTC Pace
TTY (800) 662-1220
EC 03549135 Extended MLTC LLC (866) 389-2656 Partial LTC
(855) 899-6492
ED 03253707 Elderplan, Inc., Homefirst (866) 389-2656 Partial LTC
TTY (800) 662-1220
EE 04342343 Excellus – Blue Option Plus - HARP HARP
EG 03690851 KALOS Health (800) 894-2464 Partial LTC
(ErieNiagara MLTCP Inc) TTY (800) 662-1220

EH 03234044 RiverSpring at Home (800) 370-3600 Partial LTC

(Elderserve Health Inc) TTY (866) 236-5800

FZ 04190745 Fallon Health Weinberg PACE (855) 665-1113 LTC PACE

(TTY 711)
GD 01788325 Fidelis Care at Home (888) 343-3547 Partial LTC
TTY (800) 695-8544
HA 06259723 Hamaspik MAP INC (855) 552-4642 Medicaid Adv
TTY/TDD: (855) 854- Plus
4030
H1 02104369 Senior Health Partners (866) 585-9280 Partial LTC
(Healthfirst PHSP, Inc) TTY (800) 662-1220
HC 03522947 Hamaspik Choice (855) 552-4642 Partial LTC
TTY (877) 544-6220
HF 04003696 Healthfirst PHSP Person Wellness Plan (866) 463-6743 HARP
HI 04082293 HIP of Greater NY (646) 447-5000 HARP
HT,98,99 00313979 HIP of Greater NY (646) 447-5000 Mainstream
HW 01131584 HIP Westchester (646) 447-5000 Mainstream
HY 01202822 HIP Nassau (646) 447-5000 Mainstream
IC 03866960 iCircle Service of the Finger Lakes (844) 424-7253 Partial LTC
TTY (711)
IE 01208997 Independent Health Association (800) 736-5771 Mainstream

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Plan Code Plan ID# PCP Provider Name Telephone Number Plan Type
IH 04342325 Independent Health’s MediSource HARP
Connect - HARP
IL 01278899 ElderOne (855) 457-4636 LTC Pace
(Independent Living for Seniors) TTY (800) 662-1220
IP 05922454 Integra MLTC Inc MAP (877) 388-5195 Medicaid Adv
Plus
IS 01519162 PACE CNY (888) 728-7223 LTC Pace
(Loretto HMO) TTY (800) 662-1220
IT 03475427 Integra MLTC, Partial Cap (855) 661-0002 Partial LTC
TTY (711)
KP 01617894 Healthplus HP, LLC (800) 454-3730 Mainstream
KX 02644562 Healthplus HP, LLC (866) 805-4589 Partial LTC
TTY (800) 855-2880
M3 01825947 Evercare Choice (877) 255-3678 (845) Partial LTC
569-2228
MA 04342334 MVP Harmonious Health Care Plan - HARP
HARP
MC 06097149 MetroPlus Health Ultracare 855-552-4642 MC
MF 03594052 Montefiore HMO (855) 556-6683 Partial LTC
TTY (711)
MH 03420808 HealthFirst Complete Care (888) 260-1010 Medicaid Adv
(HealthFirst Health Plan) TTY (888) 542-3821 Plus
MO 01403176 United HealthCare of NY, Inc. (877) 842-3210 Mainstream
MP 03466906 MetroPlus MLTC (855) 355-6582 Partial LTC
TTY (800) 881-2812
MR 00477023 Excellus (800) 920-8889 Mainstream
MT 04053201 Metroplus Health Plan Inc. (800) 597-3380 HARP
MV 01111375 MVP, Inc. (800) 684-9286 Mainstream
MZ 01778523 Senior Network Health (888) 355-4764 Partial LTC
TTY (800) 662-1220
N6 02188296 Fallon Health Weinberg (716) 250-3100 (866) Partial LTC
882-8185
NA 04122776 Elderwood (866) 843-7526 Partial LTC
(Niagara Advantage Health Plan) TTY (711)
NC 04004486 HealthierLife (800) 749-0820 HARP
OD 02191582 Amida Care Inc., (VidaCare, Inc., SN) (646) 786-1800 SNP
OM 02191362 Metroplus Partnership Care SN (800) 303-9626 SNP
PC 03581413 Prime Health Choice (855) 777-4630 Partial LTC
TTY (855) 777-4613
PO 04099212 Partners Health Plan (855) 747-5483 FIDA-IDD
TTY (711)
SF 01479670 HealthFirst PHSP, Inc. (866) 463-6743 Mainstream
SP 01421250 Fidelis Care New York (800) 749-0820 Mainstream
SP 01751046 Fidelis Care New York (800) 749-0820 Mainstream

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Plan Code Plan ID# PCP Provider Name Telephone Number Plan Type
SW 03459881 Senior Whole Health (877) 353-0185 Partial LTC
TTY (711)
TN 04342292 Molina Healthcare Plan of NY HARP
TO 03685774 Molina Healthcare of New York Inc. (315) 476-7921 Mainstream
(TONY)
TS 03056544 Total Senior Care PACE (866) 939-8613 LTC Pace
TTY (800) 662-1220
UC 04054091 United Healthcare of New York (877) 842-3210 HARP
VA 03529059 Nascentia Health (855) 877-8868 Partial LTC
(VNA Homecare Options) TTY (711)
VC 01750467 VNS Choice (888) 867-6555 Partial LTC
TTY (711)
VL 03420399 Village Care Max (800) 469-6292 Partial LTC
TTY (800) 662-1220
VM 04682248 VillageCareMAX Total Advantage (800) 469-6292 Medicaid Adv
TTY (800) 662-1220 Plus
VS 03420871 VNS Choice Select Health SNP (866) 469-7774 SNP

YD 02738989 Fidelis Care Dual (718) 896-6500 Medicaid

Advantage
YF 02927631 Fidelis Care MAP (877) 533-2404 Medicaid Adv
TTY (800)558-1125 Plus
YH 02932896 Senior Whole Health MAP (877) 353-0185 Medicaid Adv
TTY (711) Plus
YL 03173113 Elderplan MAP (866) 386-9437 Medicaid Adv
TTY (800) 662-1220 Plus
YN 02914056 VNS Choice Plus M/M (866) 597-6674 Medicaid Adv
TTY 711 Plus
YO 03173080 Empire MediBlue HealthPlus Dual Plus (866) 805-4589 Medicaid Adv
(HMO D-SNP) (HealthPlus HP) TTY (800) 855/2880 Plus
YU 03238240 United HealthCare of New York (866) 362-3368 Medicaid
Advantage
YW 02645710 Wellcare of New York M/M (866) 491-5746 Medicaid
Advantage

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County/District Codes
Below is a listing of all the counties and their corresponding district codes.

01 Albany 34 Orleans
02 Allegany 35 Oswego
03 Broome 36 Otsego
04 Cattaraugus 37 Putnam
05 Cayuga 38 Rensselaer
06 Chautauqua 39 Rockland
07 Chemung 40 St. Lawrence
08 Chenango 41 Saratoga
09 Clinton 42 Schenectady
10 Columbia 43 Schoharie
11 Cortland 44 Schuyler
12 Delaware 45 Seneca
13 Dutchess 46 Steuben
14 Erie 47 Suffolk
15 Essex 48 Sullivan
16 Franklin 49 Tioga
17 Fulton 50 Tompkins
18 Genesee 51 Ulster
19 Greene 52 Warren
20 Hamilton 53 Washington
21 Herkimer 54 Wayne
22 Jefferson 55 Westchester
23 Lewis 56 Wyoming
24 Livingston 57 Yates
25 Madison 66 New York City
26 Monroe 97 Office of Mental Health
Administered
27 Montgomery
98 Office for People with
28 Nassau
Developmental Disabilities
29 Niagara
99 Breast & Cervical Cancer
30 Oneida Treatment Program
31 Onondaga
32 Ontario
33 Orange

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