Change Healthcare Network Outage
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On 2/21/24, VillageCareMAX was alerted by Change Healthcare about a network outage that is disrupting Change Healthcare’s ability to deliver services. This impacts providers who use Change Healthcare to send member eligibility verifications, 837 files and paper-to-electronic claims scanning.
Notification to Providers Regarding Vaccines and Insulin
In accordance with the new 2023 Center for Medicare and Medicaid Services (CMS) Inflation Reduction Act (IRA) provisions regarding vaccines and insulin, VillageCareMAX will be implementing a few changes for our members.
Notification to Providers Regarding Vaccines and Insulin (PDF)
COVID-19 Related Alerts
Update 2-2-2022
Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes
Due to concerns about increased transmissibility of the SARS-CoV-2 Omicron variant, this guidance is being updated to enhance protection for healthcare personnel, residents, and visitors and to address concerns about potential impacts on the healthcare system given a surge in SARS-CoV-2 infections. These updates will be refined as additional information becomes available to inform recommended actions.
Guidance Available on Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes.
Nursing homes are now required to report the first week of COVID-19 data to the Centers for Disease Control and Prevention (CDC) beginning May 8 but no later than May 17.
Update 4-3-2020
COVID-19 Long-Term Care Facility Guidance
The recommendations include:
- Nursing Homes should immediately ensure that they are complying with all CMS and CDC guidance related to infection control
- CMS/CDC urges State and local leaders to consider the needs of long-term care facilities with respect to supplies of PPE and COVID-19 tests
- Long-term care facilities should immediately implement symptom screening for all staff, residents and visitors – including temperature checks
- Long-term care facilities should ensure all staff are using appropriate PPE when they are interacting with patients and residents, to the extent PPE is available and per CDC guidance on conservation of PPE
- To avoid transmission within long-term care facilities, facilities should use separate staffing teams for COVID-19-positive residents to the best of their ability, and work with State and local leaders to designate separate facilities or units within a facility to separate COVID-19 negative residents from COVID-19 positive residents and individuals with unknown COVID-19 status
COVID-19 Long-Term Care Facility Guidance
COVID-19 Guidance for Medicaid Providers
The health and safety of healthcare workers and our ability to provide and support patient care remain our priorities. Recently, community-wide transmission of COVID-19 has occurred in the United States (US) including New York State, and the number of both Persons Under Investigation (PUIs) and confirmed cases are increasing in NYS. The situation with COVID-19 infections identified in the United States continues to evolve and is very rapidly changing. It is important for all agencies to keep apprised of current guidance by regularly visiting the Centers for Disease Control and Prevention (CDC) and NYSDOH websites, as well as the NYSDOH Health Commerce System (HCS), for the most up-to-date information for healthcare providers.
NYS DOH Guidance for Medicaid Providers
Centers for Medicare & Medicaid Services (CMS): Current Emergencies
Centers for Medicare & Medicaid Services (CMS): Current Emergencies
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.
Provider Benefits
- 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.
Non-Participating Providers
- 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:
Waiver of Liability Form
Provider Portals
The VillageCareMAX provider portals were designed with you and your staff in mind. Each of the portals are offered to assist with specific actions you are looking for. Please see the descriptions below:
Claims & Eligibility Provider Portal
This portal is a quick, convenient, and secure way to verify member eligibility, review claims status, submit claims inquiry request and much more. The portal is available 24 hours a day, 7 days a week.
Authorizations Provider Portal
This VillageCareMAX provider portal integrates with GuidingCare Care Management and is a tool for providers to electronically submit authorizations, step through criteria and receives automated responses and real-time updates. Providers can check on the status of authorizations, add supporting documentation for authorizations, update authorization with discharge information and submit appeals on authorizations in one easy-to-use interface.
*Provider portal registration is required. In order to register, you must be an in-network provider with a valid NPI number.
Provider Portal Quick Reference Guide (PDF)
Provider Portal Authorizations User Guide (PDF)
CLAS Training
Culturally and Linguistically Appropriate Services Training
The Culturally and Linguistically Appropriate Services (CLAS) Training Program is a training required by VillageCareMAX and the Office for Minority Health (OMH) at the U.S Department of Health and Human Services (HHS). As a VCMAX provider, you are required to complete this training. The purpose of the Program is to communicate with providers the 15 National CLAS Standards broken up into (4) categories: Principal Standard; Governance, Leadership and Workforce; Communication and Language Assistance; and Engagement, Continuous Improvement, and Accountability.
ACTION REQUIRED: Please use the attestation link below to attest to completing this required training on your behalf and or on the behalf of your Organization no later than December 31, 2024. A receipt of your completed Attestation Form will ensure the VillageCareMAX and provider remain compliant in these requirements by CMS and OMH.
Model of Care Training
The Special Needs Plans (SNP) Model of Care Training Program is a basic training required by The Centers for Medicare & Medicaid Services (CMS) for all contracted medical Providers and staff. As per CMS, “the Model of Care is a vital quality improvement tool and integral component for ensuring that the unique needs of each enrollee are identified by the SNP and addressed through the plan's care management practices.” You are required to complete this training for all SNP Plans. The purpose of the training is to identify how the Provider of care will support the Special Needs Plan Model of Care while understanding CMS requirements for managing those members.
ACTION REQUIRED: Please use the attestation link below to attest to completing this required training on your behalf and or on the behalf of your Organization no later than December 31, 2024. A receipt of your completed Attestation Form will ensure the VillageCareMAX and provider remain compliant in these requirements by CMS and OMH.
We’re offering a variety of resources and links designed to meet both your needs and the needs of your patients.
Helpful Links
Medicaid Provider Billing Certification
Make a Referral
Provider Bulletins
