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Information Regarding Coronavirus (COVID-19)

COVID-19 Telehealth Provider Q&A

HEDIS® Telehealth Accepted Codes

Guidance on Suspended Health Plan Utilization Review Requirements
The New York State Department of Health (NYSDOH) has provided guidance on suspension of health plan utilization review requirements for inpatient rehabilitation facilities, skilled nursing facilities and other health care providers.

NYDSOH Guidance on Suspended Health Plan Utilization Review Requirements (PDF)

Cost Sharing Waiver
The New York State Department of Financial Services (DFS), the New York State Department of Health, and the federal government are directing payers to waive patient copays, coinsurance and deductibles for certain testing and treatment due to the COVID-19 emergency. Learn more.

New York State Coronavirus 1135 Waiver
New York State was granted a Medicaid 1135 waiver from CMS on March 26, 2020. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the
CMS Current Emergencies WebsiteMS Current Emergencies Website.

NY Medicaid 1135 Waiver

Model of Care Training

The Centers for Medicare & Medicaid Services (CMS) requires Special Needs Plans (SNPs) to provide initial and annual Model of Care (MOC) training to our network providers and all out-of-network providers seen by our members routinely. This training ensures providers have knowledge of the Senior Whole Health of New York NHC population and our Model of Care.

Senior Whole Health of New York NHC Model of Care (PDF)

Please complete the 2020 training by October 31, 2020Click here to complete.

COVID-19 Provider Webinars: Please click here to view information & materials for past as well as upcoming Provider webinars.

How to build resilience and adaptive skills during the pandemic Tips for caring for the emotional health and wellness of you and your family during these uncertain times. Learn more. If you missed the live webinar, the recording is posted here

Senior Whole Health now offers Electronic Remittance (ERA) and Electronic Fund Transfer (EFT). If you are currently enrolled with Change Healthcare ERA or EFT you should be seeing your payments electronically. If you are not enrolled, you can switch from paper to electronic payments over the phone, online, through the mail or via fax.

Senior Whole Health of New York is dedicated to providing our members with the best care possible and keeping them healthy and independent.

Senior Whole Health of New York Nurse Care Managers are assigned to each member. These nurses help plan, organize and arrange services to effectively coordinate medical, behavioral, pharmaceutical, and social and community based services with the providers, local elder services agency and others involved in our members' care. Senior Whole Health of New York Nurse Care Managers are available by phone 24/7 to both our providers and members in order to best facilitate treatment.

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.

Click here to view the Senior Whole Health of New York Provider Manual (PDF).

Senior Whole Health's Dental Provider Manual is available through SKYGEN USA’s Provider Portal.

Click here to view Senior Whole Heath of New York's 2017 HEDIS® Measures of Focus (PDF).

Enroll in Medicare as a Provider Now! Learn more.

Visit the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) to securely and electronically submit and manage Medicare enrollment information.

First Tier, Downstream, and Related Entities (FDR) Compliance Guide & Attestation: Click here to review and complete the FDR Annual Compliance Attestation

Click here to view information about False Claims Act laws. Senior Whole Health encourages you to report fraud or suspected fraud by calling the SWH Fraud Hotline at 1-800-341-4915, our anonymous compliance hotline at 1-800-915-2108 or the Main SIU Hotline at 1-800-755-0850.

Click here to view Senior Whole Health of New York's Fraud Waste and Abuse Policy.

Last updated 08/03/2020