Information for Health Care Providers
Joining an MCO Network
Providers wishing to join a managed care organization's network can contact the plan directly and request application procedures and the minimum qualification requirements a provider must meet in order to be considered by the plan. There is no requirement in New York State law that plans accept any provider who wishes to join their network. However, plans must maintain a network that is sufficient to deliver comprehensive services to their enrolled population. The Division of Managed Care and Program Evaluation reviews provider networks routinely to ensure enrollee access to health care. Contact DMC & DQE for problems encountered in obtaining application procedures.
Contracting with an MCO
The Division of Managed Care & Division of Quality and Evaluation (DMC & DQE) reviewsHMO and IPA provider contracts to ensure that applicable laws and regulations are adhered to. However, the specific terms, services, compensation, risk arrangements, claims procedures, quality assurance requirements, etc. of the contracts are the purview of the contracting parties. Assistance with general contracting issues may be found by contacting professional associations or provider trade organizations.
Medicaid Managed Care Program
Medicaid managed care provides comprehensive health care services to enrollees. More specific information on enrollee eligibility and conditions of Medicaid coverage should be obtained by contacting the health plan and/or eMEDNY.
- New York State's Operational Protocol for the Partnership Plan
- The Partnership Plan — New York's 1115 Medicaid Managed Care Demonstration. A copy of the original 1115 application is available by writing to omcmail@health.state.ny.us or write to: NYSDOH Division of Managed Care and Program Evaluation (DMC & DQE)
Bureau of Managed Care Program Policy and Planning
Corning Tower Room 1927
Empire State Plaza
Albany, New York 12237-0094
- Medicaid Managed Care Model Member Handbook (PDF, 312KB, 35pgs.)
- Information on HIV Special Needs Plans
Managed Care Model Contracts
- Medicaid Managed Care/Family Health Plus Model Contract - as of April 1, 2008
(PDF, 4MB, 299pg.) - Medicaid Advantage Model Contract - as of January 1, 2007 (PDF, 1.5MB, 214pg.)
To obtain a copy of a managed care model contract please send a request, identifying the contract needed, to omcmail@health.state.ny.us or write to:
NYSDOH Division of Managed Care and Division of Quality and Evaluation (DMC & DQE)Corning Tower Room 2001
Empire State Plaza
Albany, New York 12237-0094