INFORMATION FOR ALL PROVIDERS MANAGED CARE ... - …

1 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 Version 2021-1 March 8, 2021 Page 2 of 7 Table of Contents PREPAID CAPITATION PLANS (PCP) .. 3 COUNTY/DISTRICT 7 INFORMATION for All PROVIDERS MANAGED Care INFORMATION Version 2021-1 March 8, 2021 Page 3 of 7 Prepaid Capitation Plans (PCP) Key: Plan Type Abbreviatio n descriptio n Model Co ntract Link Partial LTC Lo ng Term Care: Partial Capitatio n LTC Pace Lo ng Term Care: PACE Medicaid Adv Plus Lo ng Term Care: Medicaid Advantage Plus FHP Family Health Plus SNP Special Needs Plan Mainstream Medical Assistance Medicaid Advantage Medicaid Advantage FIDA IDD Fully Integrated Duals Advantage Plan Intellectual and Developmental Disabilities HARP Health and Recovery Plan Plan Code Plan ID# PCP Provider Name Telephone Number Plan Type 82 00477156 Affinity Health Plan, Inc.

2 (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 Catholic MLTC - ArchCare Senior Life (866) 263-9083 TTY (800) 662-1220 LTC Pace AF 04342307 Affinity Health Plan Enriched Plan (800) 553-8247 HARP AG 03481927 AgeWell New York, LLC (866) 586-8044 TTY (800) 662-1200 Partial LTC AH 03458546 Aetna Better Health (855) 456-9126 TTY (711) Partial LTC AP 03466800 Archcare-Catholic MANAGED LTCS MLTC (866) 467-9351 TTY (711) Partial LTC AZ 05572692 AgeWell NY LLC MAP (866)237-3210 TTY (800) 662-1200 Medicaid Adv Plus C2 01249265 HealthNow NY, Inc. (Community Blue) (716) 887-6900 Mainstream C7 01234037 CenterLight HealthCare (877) 226- 8500 TTY (800) 650-2774 LTC Pace CC 03320725 Complete Senior Care (888)303-4333 TTY (716) 285-8248 LTC Pace CD 04342316 Capital District Physician s Health Plan HARP CG 01183013 Capital District Physician s Health Plan (518) 641-3500 (800) 926-7626 Mainstream INFORMATION for All PROVIDERS MANAGED Care INFORMATION Version 2021-1 March 8, 2021 Page 4 of 7 Plan Code Plan ID# PCP Provider Name Telephone Number Plan Type CH 03072740 Catholic Health Life PACE (855) 671-3341 TTY (716) 819-5084 LTC Pace CP 03506989 Centers Plan for Healthy Living (855) 270-1600 TTY (800) 421-1220 Partial LTC CM 05357520 Centers Plan for Medicaid Advantage Plus (833)-274-5627 TTY.

3 1800 421 1220 Medicaid Adv Plus EA 05410146 Elderserve Health MAP, INC 1-800-580-7000 TTY/TDD: 711 Medicaid Adv Plus E7 01674982 Senior Care Connection (the Eddy) (855) 376-7888 TTY (800) 662-1220 LTC Pace EC 03549135 Extended MLTC LLC (866) 389-2656 (855) 899-6492 Partial LTC ED 03253707 Elderplan, Inc dba Homefirst (866) 389-2656 TTY (800) 662-1220 Partial LTC EE 04342343 Excellus Blue Option Plus - HARP HARP EG 03690851 KALOS Health (800) 894-2464 TTY (800) 662-1220 Partial LTC EH 03234044 RiverSpring at Home (Elderserve) (800) 370-3600 TTY (866) 236-5800 Partial LTC FZ 04190745 Fallon Health Weinberg PACE (855) 665-1113 (TTY 711) LTC PACE GD 01788325 Fidelis Care at Home (888) 343-3547 TTY (800) 695-8544 Partial LTC HA 06259723 Hamaspik MAP INC (855) 552-4642 TTY/TDD: (855) 854-4030 Medicaid Adv Plus H1 02104369 Senior Health Partners, Inc.

4 (866) 585-9280 TTY (800) 662-1220 Partial LTC HC 03522947 Hamaspik Choice (855) 552-4642 TTY (877) 544-6220 Partial LTC 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 TTY (711) Partial LTC IE 01208997 Independent Health Association (800) 736-5771 Mainstream INFORMATION for All PROVIDERS MANAGED Care INFORMATION Version 2021-1 March 8, 2021 Page 5 of 7 Plan Code Plan ID# PCP Provider Name Telephone Number Plan Type IH 04342325 Independent Health s MediSource Connect - HARP HARP IL 01278899 Elder One (Independent Living for Seniors) (855) 457-4636 TTY (800) 662-1220 LTC Pace IP 05922454 Integra MAP (877) 388-5195 Medicaid Adv Plus IS 01519162 PACE CNY (Loretto HMO) (888) 728-7223 TTY (800) 662-1220 LTC Pace IT 03475427 Integra MLTC, Inc (855) 661-0002 TTY (711) Partial LTC KP 01617894 Healthplus HP, LLC (800) 454-3730 Mainstream KX 02644562 Amerigroup Community Connections (Empire BC/BS Amerigroup Health Plus) (866) 805-4589 TTY (800) 855-2880 Partial LTC M3 01825947 Evercare Choice, Inc.

5 (Elant Choice) (877) 255-3678 (845) 569-2228 Partial LTC MA 04342334 MVP Harmonious Health Care Plan - HARP HARP MF 03594052 Montefiore HMO (855) 556-6683 TTY (711) Partial LTC MH 03420808 HealthFirst Complete Care ( MANAGED Health, Inc. MAP) (888) 260-1010 TTY (888) 542-3821 Medicaid Adv Plus MO 01403176 United HealthCare of NY, Inc. (877) 842-3210 Mainstream MP 03466906 MetroPlus MLTC (855) 355-6582 TT Y (800) 881-2812 Partial LTC 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, LLC (888) 355-4764 TTY (800) 662-1220 Partial LTC N6 02188296 Total Aging in Place (Fallon Health Weinberg) (716) 250-3100 (866) 882-8185 Partial LTC NA 04122776 Niagara Advantage Health Plan LLC (d/b/a Elderwood) (866) 843-7526 TTY (711) Partial LTC NC 04004486 HealthierLife (800) 749-0820 HARP OD 02191582 Amida Care Inc.

6 , (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 TTY (855) 777-4613 Partial LTC PO 04099212 Partners Health Plan FIDA IDD (855) 747-5483 TTY (711) F ID A-IDD 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 INFORMATION for All PROVIDERS MANAGED Care INFORMATION Version 2021-1 March 8, 2021 Page 6 of 7 Plan Code Plan ID# PCP Provider Name Telephone Number Plan Type SW 03459881 Senior Whole Health (877) 353-0185 TTY (711) Partial LTC TN 04342292 Molina Healthcare Plan of NY HARP TO 03685774 Molina Healthcare of New York Inc. (TONY) (315) 476-7921 Mainstream TS 03056544 Total Senior Care Inc.

7 (866) 939-8613 TTY (800) 662-1220 LTC Pace UC 04054091 United Healthcare of New York (877) 842-3210 HARP VA 03529059 Nascentia Health (VNA Homecare Options) (855) 877-8868 TTY (711) Partial LTC VC 01750467 VNS Choice (888) 867-6555 TTY (711) Partial LTC VL 03420399 Village Senior Services (Village Care Max) (800) 469-6292 TTY (800) 662-1220 Partial LTC VM 04682248 VillageCareMAX Total Advantage Plan (800) 469-6292 TTY (800) 662-1220 Medicaid Adv 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 TTY (800)558-1125 Medicaid Adv Plus YH 02932896 Senior Whole Health M/M Plus (877) 353-0185 TTY (711) Medicaid Adv Plus YL 03173113 Elderplan MAP (866) 386-9437 TTY (800) 662-1220 Medicaid Adv Plus YN 02914056 VNS Choice Plus M/M (866) 597-6674 TT Y 711 Medicaid Adv Plus YO 03173080 Empire Blue Cross Blue Shield HealthPlus (Amerigroup Advantage Plus) (866) 805-4589 TTY (800) 855/2880 Medicaid Adv Plus YU 03238240 United Health Care M/M (866) 362-3368 Medicaid Advantage YW 02645710 Wellcare of NYM/M (866) 491-5746 Medicaid Advantage INFORMATION for All PROVIDERS MANAGED Care INFORMATION Version 2021-1 March 8, 2021 Page 7 of 7 County/District Codes Below is a listing of all the counties and their corresponding district codes.

8 01 Albany 02 Allegany 03 Broome 04 Cattaraugus 05 Cayuga 06 Chautauqua 07 Chemung 08 Chenango 09 Clinton 10 Columbia 11 Cortland 12 Delaware 13 Dutchess 14 Erie 15 Essex 16 Franklin 17 Fulton 18 Genesee 19 Greene 20 Hamilton 21 Herkimer 22 Jefferson 23 Lewis 24 Livingston 25 Madison 26 Monroe 27 Montgomery 28 Nassau 29 Niagara 30 Oneida 31 Onondaga 32 Ontario 33 Orange 34 Orleans 35 Oswego 36 Otsego 37 Putnam 38 Rensselaer 39 Rockland 40 St. Lawrence 41 Saratoga 42 Schenectady 43 Schoharie 44 Schuyler 45 Seneca 46 Steuben 47 Suffolk 48 Sullivan 49 Tioga 50 Tompkins 51 Ulster 52 W arren 53 W ashington 54 Wayne 55 W estchester 56 Wyoming 57 Yates 66 New York City 97 Office of Mental Health Administered 98 Office for People with Developmental Disabilities 99 Breast & Cervical Cancer Treatment Program