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)
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.
Coming Soon
2025 VillageCareMAX Provider Education Webinar
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
