Information for Providers
VillageCareMAX fully supports the Patient-Centered Medical Home initiative. Our team collaborates with local community services and the patient’s providers to effectively coordinate medical, behavioral, pharmaceutical, and social and community-based services.
The result is a comprehensive, team-based care plan that anticipates and adapts to the changing needs of each member, striving to keep them secure, independent and living in the comfort of their own home.
As a provider, you want to spend your time taking care of your patients and we’ll take care of the rest.
- Ability to maintain current referral patterns
- Care management team to assist with resource management
- Around-the-clock access to a nurse coordinator for information to facilitate service coordination
Participating Provider Responsibilities
- Check governmental exclusion lists on a monthly basis, including the U.S. Dept. of Health and Human Services Office of the Inspector General (“OIG”) List of Excluded Individuals and Entities and the NY Office of the Medicaid Inspector General (“OMIG”) List of Exclusions to ensure that no employee/staff is excluded from participation in government programs.
- A non-participating provider may file an appeal when VillageCareMAX denies claims payment fully or partially. The appeal must include a signed Waiver of Liability form that waives the non-participating provider’s rights to collect payment from the member. VillageCareMAX cannot start the review of your appeal until the signed form is received. Failure to submit the signed form within the required timeframe will result in dismissal of your appeal. The Waiver of Liability Form can be accessed at the below link:
We’re offering a variety of resources and links designed to meet both your needs and the needs of your patients.