New York Payer Configuration and Requirements Tables
The payer configuration table is a valuable resource to help you understand the specific requirements for each payer contract as they relate to the integration process. By referencing this table, you can ensure the correct configuration of payer contracts, maintain compliance, and streamline workflows. Use this topic as a quick reference to verify the scope of each payer’s requirements and to facilitate a smooth integration process.
Aetna Better Health
| Payer Configurations and Requirements | Aetna Better Health |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Contact Payer Directly |
| DX Code is Payer or Provider Managed | Payer Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 300 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Agewell
| Payer Configurations and Requirements | Agewell |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 300 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Required as of 8/2021 |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Centerlight PACE
| Payer Configurations and Requirements | Centerlight PACE |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Payer Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 300 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Required |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Elderplan
| Payer Configurations and Requirements | Elderplan |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Payer Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 300 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
EverCare
| Payer Configurations and Requirements | EverCare |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Payer Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 300 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Required as of 7/2021 |
| Rate is Payer or Provider Managed | Payer Managed |
| Referring Physician Required | Not in Scope |
Fidelis
| Payer Configurations and Requirements | Fidelis |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 300 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Healthfirst
| Payer Configurations and Requirements | Healthfirst |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Payer Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 300 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Molina Healthcare
| Payer Configurations and Requirements | Molina Healthcare |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Contact Payer Directly |
| DX Code is Payer or Provider Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 300 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Nascentia
| Payer Configurations and Requirements | Nascentia |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Payer Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 300 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Riverspring
| Payer Configurations and Requirements | Riverspring |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 300 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Senior Whole Health
| Payer Configurations and Requirements | Senior Whole Health |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 300 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Required as of 8/2021 |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
United Health Care
| Payer Configurations and Requirements | United Health Care |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 300 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
VNSNY
| Payer Configurations and Requirements | VNSNY |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Required |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Payer Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 300 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not in Scope |
| Rate is Payer or Provider Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Your Choice At Home
| Payer Configurations and Requirements | Your Choice At Home |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not in Scope |
| Communications Module Availability | Available |
| DX Code is Payer or Provider Managed | Payer Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 300 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Required |
| Rate is Payer or Provider Managed | Payer Managed |
| Referring Physician Required | Not in Scope |