For Providers

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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.

 Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes

 

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.

 Guidance for Nursing Homes

 

Update 4-3-2020

COVID-19 Long-Term Care Facility Guidance

The recommendations include:

  1. Nursing Homes should immediately ensure that they are complying with all CMS and CDC guidance related to infection control
  2. 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
  3. Long-term care facilities should immediately implement symptom screening for all staff, residents and visitors – including temperature checks
  4. 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
  5. 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 Portal

Provider Portal Login

The 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

 

Model of Care Training

 

 


Helpful Links


Provider Bulletins

Page Last Updated: 07/05/2022