Posted in BCBS Empire NY, Updates

Empire BCBS (NY) and SOMOS IPA Utilization Management

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:

FRONT OF THE CARD
BACK OF THE CARD

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.

For more information please click here.

Posted in Insurance, Training, Updates

EmblemHealth & SOMOS IPA LLC. (NY Providers)-Managing Entity, effective 10/01/2020

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)

Contact Information:

  1. Member eligibility – please call EmblemHealth provider number 866-447-9717
  2. Provider Contact Information for SOMOS IPA, LLC:
  3. Claims Submission: PO Box 211473, Eagan, MN 55121
  4. Claim Inquires: P: 844-990-0255
  5. Preauthorizations: Online https://smnyportal.valence.care P: 844-990-0255/F: 877-590-8003

Note: providers should check to see if they are in-network and are able to see SOMOS patients.

For a complete announcement from SOMOS Community, please click here .

For an EmblemHealth announcement, please click here.

#EmblemHealth, #SOMOS,#IPA