Reminder that effective 10/01/2020- SOMOS IPA will assume the administrative functions for several Empire HealthPlus Plans:
Medicaid Managed Care (MMC)
Health and Recovery Plan (HARP)
Child Health Plus (CHPlus)
Essential Plan programs
SAMPLE EMPIRE SOMOS IPA CARDS:
Contacting SOMOS for patient Eligibility, benefits and authorizations: OON and IN providers
Credentialing process: • SOMOS IPA providers: SOMOS will handle all credentialing for its participating providers. This includes the submission of any demographic changes or terminations. • Non-SOMOS IPA providers: Providers who are not contracted with the IPA must continue to follow the Empire processes.
As of October 1,2020 Somos IPA partnered up with EmblemHealth, to become a managing entity for some Medicaid, ChildHealth Plus, HARP. And Essential Plan members.
Below are the examples of SOMOS Emblem Health Cards: Notice SOMOS.
SOMOS IPA LLC-will conduct utilization management and will process claims for their assigned memberships. Providers that belong to SOMOS IPA and EmblemHealth, that provide services for SOMOS members, will need to contact SOMOS for prior authorizations and send their claims to SOMOS address. (see below)
Member eligibility – please call EmblemHealth provider number 866-447-9717