Article Rating

  • 0 Rating(s)
  • 0
  • 0
  • 0
  • 0
  • 0
Actions
Share

CDPHP to Bring EI Providers In-Network

CDPHP to Bring EI Providers In-Network

The Bureau of Early Intervention (BEI) and Public Consulting Group (PCG), the State Fiscal Agent, are pleased to announce that Capital District Physicians’ Health Plan (CDPHP) has agreed to bring Early Intervention (EI) Providers in-network for all EI services provided under New York State Regulated insurance plans[1].

In order to be credentialed and approved as in-network for CDPHP, EI Billing Providers must enroll with the Council for Affordable Quality Healthcare (CAQH) AND complete two CDPHP forms. Instructions for completing the required forms are below.

CAQH Enrollment

EI Billing Providers must enroll with the Council for Affordable Quality Healthcare (CAQH) to be credentialed as an in-network provider with CDPHP. EI Billing Providers that have not yet enrolled with CAQH, and wish to be approved as in-network for CDPHP, must enroll as soon as possible. The link to enroll is provided below:

https://proview.caqh.org/PR/Registration

When enrolling with CAQH online, Providers will be asked to submit several types of information and documents (see lists below). Please be prepared to provide the required information and documents when you begin the online enrollment process:

Information Required for CAQH Enrollment:

  • Basic Personal Information
  • Education and Training
    • Medical/Professional school
    • Graduate school
    • Internships and residencies
    • Fellowships and preceptorships
    • Teaching appointment
  • Specialties and Board Certification
  • Practice Location Information
    • Practice name and type
    • Address and contact information
    • Billing, office manager, and credentialing contact
    • Services, certifications, limitations, and hours of operation
    • Partners and covering colleagues
  • Hospital Affiliation Information
  • Malpractice Insurance Information
  • Work History and References
  • Disclosure and Malpractice History

Documentation Required[2] for CAQH Enrollment:

  • IRS Form W-9(s)
  • Drug Enforcement Administration (DEA) Certificate
  • Controlled and Dangerous Substances (CDS) Certificate
  • State medical license(s) or non-medical license(s)
  • Various identifications numbers (UPIN, Medicare, Medicaid, etc.)
  • Malpractice insurance policy(ies)

Enrollees will be asked to authorize participating organizations to access your application data. PCG advises that EI Billing Providers do authorize access, so that in the future additional payers and/or health plans can use this information to credential you or your organization.

When enrolling therapists with CAQH:

  • If a provider organization is assisting therapists with CAQH enrollment, there is a specific module, CAQH ProView Practice Administrator, that will facilitate enrolling multiple therapists. Use the following link to enroll multiple therapists within your organization: https://proview.caqh.org/Login?Type=PM
  • If you are an individual therapist that works for more than one agency, and you are concerned with ensuring that CDPHP pays the correct billing provider, please be sure to list ALL practice locations during CAQH enrollment (with appropriate Tax ID numbers). Doing this ensures that you can be credentialed and set up to bill for multiple locations or Tax ID numbers.

If you have enrollment issues or questions, contact the CAQH Provider Help Desk – see below.

CAQH Provider Help Desk:

Phone: (888) 599-1771

Email: providerhelp@proview.caqh.org

Hours: Monday-Thursday – 7am-9pm; Friday – 7am-7pm

CDPHP Forms

EI Providers that serve CDPHP-covered children will begin receiving, via email from PCG, forms required to join CDPHP’s network. These forms include:

  • CDPHP Data Collection Form
  • Practitioner Demographic Change Request Form[3]

These forms, which will be partially pre-populated, must be completed and returned to PCG at NYSFAEIP@pcgus.com.

Please Note: On the CDPHP forms, enrollees will also be asked to confirm that background checks and verifications of the Federal Exclusion lists are being completed by the employer (i.e. billing agency or provider). This is to ensure that providers are abiding by this New York State requirement, and must be completed in order to proceed with credentialing.

Once credentialing has been completed via CAQH, and the required forms have been returned, CDPHP will review the information provided and send contracts to providers directly. Please note that different types of EI Billing Providers may have slightly different credentialing processes and timelines. For Behavior Health, Physical Therapy, and Occupational Therapy, providers will have to undergo a full credentialing process (90 days). CDPHP has agreed to a modified credentialing process for providers of Speech Therapy, Nutrition, and Audiology. Benefits to this modified process include:

  • A dedicated representative to assist the provider
  • Less paperwork for the provider to complete
  • Shorter timeframe from enrollment to approval

For some types of providers, CDPHP may require a provider to attest that they are available to see CDPHP patients for no less than a specific number of hours each week.

If you have any questions about the process, please contact the PCG Customer Call Center at (866) 315-3747.


[1] If you are already in-network with CDPHP, please disregard this notice as no further action is required on your part.

[2] Please note that certain documents may not be applicable to all provider types. For example, DEA and CDS Certificates are only applicable to physicians.

[3] The Practitioner Demographic Change Request Form asks if provider is enrolled with CAQH. If yes, then provider must enter in their CAQH Provider ID number. Forms cannot be returned to PCG until after the completion of the CAQH enrollment.

Article ID: 386, Created On: 3/16/2018, Modified: 6/15/2018

Feedback (0)