NEW YORK STATE
MEDICAID PROGRAM
INFORMATION FOR ALL PROVIDERS
THIRD PARTY INFORMATION
Information for All Providers – Third Party Information
Table of Contents
THIRD PARTY HEALTH RESOURCES ................................................................................................................ 2
INSURANCE COVERAGE CODES ......................................................................................................................... 3
BENEFICIARY OTHER INSURANCE CODES..................................................................................................... 5
LONG TERM CARE HEALTH INSURANCE CARRIER CODES ................................................................... 10
PREPAID CAPITATION PLANS (PCP)................................................................................................................ 11
COUNTY/DISTRICT CODES ................................................................................................................................. 13
Version 2009-3
April 9, 2009
Page 1 of 13
Information for All Providers – Third Party Information
Third Party Health Resources
Insurance codes are used to identify Third Party Resources (TPR) other than Medicaid
and Medicare, under which a beneficiary has insurance coverage. Such coverage must
be utilized for payment of medical services prior to submitting claims to the Medicaid
Program.
Under the Medicaid Eligibility Verification System (MEVS), information specific to TPR
will be reported to you when you request eligibility verification of a Medicaid beneficiary.
The MEVS response via the Verifone terminal or alternate access will be a two-digit
insurance code.
For Medicaid Prepaid Capitation Plans only, the two-digit plan code and up to
20 alphabetic coverage codes, or the word “ALL” indicating what services are
covered, is displayed. The telephone response will be insurance and coverage
codes and a two-digit insurance code and up to 20 messages, or “ALL”,
indicating which services are covered.
For more detailed information on eligibility verifications, please refer to the MEVS
Provider Manual online at:
http://www.emedny.org/ProviderManuals/index.html.
The MEVS response will include information on a maximum of two third party insurance
carriers. If a Medicaid beneficiary is covered by more than two carriers, you will receive
a response of “ZZ” as an insurance code, indicating “additional insurance.”
To obtain coverage information when there are more than two carriers, call Computer
Sciences Corporation at:
(800) 343-9000.
Version 2009-3
April 9, 2009
Page 2 of 13
Information for All Providers – Third Party Information
Insurance Coverage Codes
The following codes are used in MEVS responses to designate the scope of benefits
provided by an insurance company.
Code
Description
Explanation
A
Inpatient Hospital
All inpatient services are covered except
psychiatric care.
B
Physician In-Office
Services provided in the physician’s office are
generally covered.
C
Emergency Room
Self-Explanatory.
D
Clinic
Both hospital-based and free-standing clinic
services are covered.
E
Psychiatric Inpatient
Self-Explanatory.
F
Psychiatric Outpatient
Self-Explanatory.
G
Physician In-Hospital
Physician services provided in a hospital or
nursing home are covered.
H
Drugs No Card
Drug coverage is available but a drug card is
not needed.
I
Lab/X-ray
Laboratory and X-ray services are covered.
J
Dental
Self-Explanatory.
K
Drugs Co-pay
Although insurance carrier expects a copayment, you may not request it from the
beneficiary. If the insurance payment is less
than the Medicaid fee, you can bill Medicaid
for the balance, which may cover the copayment.
L
Nursing Home
Some nursing home coverage is available.
You must bill until benefits are exhausted.
M
Drugs Major Medical
Drug coverage is provided as part of a major
medical policy.
Version 2009-3
April 9, 2009
Page 3 of 13
Information for All Providers – Third Party Information
Code
Description
Explanation
N
All Physician Services
Physician services, without regard to where
they were provided, are covered.
O
Drugs
Self-Explanatory.
P
Home Health
Some home health benefits are provided.
Continue to bill until benefits are exhausted.
Q
Psychiatric Services
All psychiatric services, inpatient and
outpatient, are covered.
R
ER and Clinic
Self-Explanatory.
S
Major Medical
The following services are covered: physician,
clinic, emergency room, inpatient, laboratory,
referred ambulatory, transportation and
durable medical equipment.
T
Transportation
Medically necessary transportation is covered.
U
Coverage to Complement
Medicare
All services paid by Medicare, which require a
coinsurance or deductible payment, should be
billed to the insurance carrier prior to billing
Medicaid.
V
Substance Abuse
Services
All substance abuse services, regardless of
where they are provided, are covered.
W
Substance Abuse
Outpatient
Self-Explanatory.
X
Substance Abuse
Inpatient
Self-Explanatory.
Y
Durable Medical
Equipment
Self-Explanatory.
Z
Optical
Self-Explanatory.
All
All of the above
All services are covered.
Version 2009-3
April 9, 2009
Page 4 of 13
Information for All Providers – Third Party Information
Beneficiary Other Insurance Codes
These codes indicate other insurance carriers under which the beneficiary may be
covered.
Ins Cd
02
05
06
09
10
12
14
18
20
22
23
25
27
28
29
30
31
32
34
35
36
38
39
40
41
42
43
44
45
47
48
49
50
51
52
53
54
55
56
58
59
60
61
62
65
Description
HIP Outpatient
Other Insurance Inpt/Outpt
Group Health Inc (GHI)
Union Inpt/Outpt
HIP/HMO
BC/BS Empire
A&P Health And Welfare
Administrative Services Co
Aftra Health And Retirement
AIG
Empire BC
Airfreight Warehouse Corp
Albany International
Allied International Union
Allied Security Health & Welfare
Amalgamated Services
Amerco
American Medical Life Ins
America’s Choice Health Plan
Amerihealth Administrators
Atlantis Health
BACL5NY Welfare Fund
Bakers Local 3
Bakery Drivers Local 802
BC/BS Carefirst
BC/BS Healthflex Now
BC/BS of Alabama
BC/BS of Greater NY
Empire BS
BC/BS of Iowa-Wellmark
BC/BS of Minnesota
BC/BS of North Dakota
BC/BS of Rhode Island
BC/BS through SSA
Benefit Concepts
Benesight PCHS
Better Health Advantage
BC/BS PP
BC of NY
Capitol Administrators
Carpenters Healthcare Plan
CBSA
Central States
CENTRUS
Chatwins Healthcare Administrators
Version 2009-3
April 9, 2009
Ins Cd
66
67
69
70
71
72
74
88
90
99
Description
Christian Brothers Employees
Citywide Central Ins Program
Coalition for Care
Cole Managed Vision
Combined Welfare Fund
Coresource Inc.
Custom Coverage
Elderplan
Davis Vision
New HIP
A1
A2
A3
A4
A5
A6
A7
A8
A9
AA
AC
ACC
AD
AE
AF
AFF
AG
AH
AI
AJ
AK
AL
AM
AO
AP
AQ
AR
AS
AU
AY
AZ
Union Am Postal Workers
American Psych Systems
American Medical Life Ins Co
Anthem Life
Aetna Medicare Cost
American National
American Pioneer Life Ins Co
Alta Health Strategies
Wells Fargo
Accident Insurance
Aetna Life Insurance Co
AMERIGROUP Community Care
Aetna Variable Annuity Life Ins
Countryway Insurance Company
American Family Life Insurance
Affinity Health Plan
Allstate Life Insurance Co
Amalgamated Life Ins Co Inc
Allstate Insurance CO
Absent Parent Responsibility
Allied Benefit Administrators
American Group Administrators
Americorps
Alta Rx Prescription Drugs
AARP
American Integrity Ins Co
ArchCare Advantage
Assoc Plan Admin Inc (APA)
American Medical Ins Co
Virginia Surety Company Inc
American Progressive Health Ins Co
B1
B2
BC/BS Highmark
BS of Florida
Page 5 of 13
Information for All Providers – Third Party Information
Ins Cd
B3
B4
B5
B6
B7
BA
BB
BB1
BCN
BE
BF
BH
BI
BL
BM
BN
BO
BP
BQ
BR
BS
BT
BV
BW
BY
BZ
Description
BS of Massachusetts
BC/BS of Tennessee
Anthem BC/BS Ohio
BC/BS of New Jersey
Blue Choice Preferred
Banker’s Life Company
Banker’s Multiple Life Ins Co
Regence BC/BS of Oregon
BC/BS of Nebraska
BS Western NY
Benefit Trust Life Ins Co
BS Northeastern NY
BS Western NY
BC New Jersey
BS New Jersey
BC/BS of Central NY–Excellus BC/BS
BC/BS of Northeastern NY
BC/BS of Western NY
BC/BS of Connecticut
BC/BS of Florida
Dental Pay
BC/BS Massachusetts
BC/BS of Vermont
BC Florida
BC of Massachusetts
BC of Northeastern PA
C1
C3
C4
C5
C6
C8
C9
CA
CB
CBS
CC
CCM
CD
CE
CF
CH
CHC
CJ
CK
CL
CM
CN
CO
CR
CS
BC Capital (Pennsylvania)
Capital District Physicians Health Plan
CIGNA
Community Blue (Buffalo)
Choicecare
Confederation Life Ins
Claim Management Services
Tricare Region 1 Claims/CHAMPUS
Colonial Penn Franklin Ins Co
Corporate Benefit Services of America
Continental Assurance Co
Comprehensive Care Mgmt. Group
Continental Casualty Co
BC/BS Michigan
BC/BS California
Chubb Life America
Coventry Health Care
Columbian Mutual Life Ins Co
Combined Life Ins Co of NY
Union Service Employee
Comm Travelers Mutual Ins Co
Catskill School Emp Ben Fund Union
Companion Life Ins Co
Consolidated Mutual Ins Co
Continental American Life Ins Co
Version 2009-3
April 9, 2009
Ins Cd
CT
CU
CY
Description
Continental Ins Co
CSEA Union
BC/BS Greater NY HMO
D1
D2
D3
D4
D5
D6
D7
D8
D9
DA
DB
DC
DE
DF
DG
DH
DI
DJ
DK
DL
DP
DR
DS
DV
DW
DX
BC/BS of the National Capitol Area
ERISCO
Pro Ins Agentents Grp
Oxford Ins Co
DC 37 Health & Security Plan
Benefit Management of Maine
BS of NE Pennsylvania
Chesterfield Resources Inc
Local 32 Health & Pension Fund Union
Benefit Administrators Ins
BC California
Benefit Management Services
BC/BS Delaware
BC/BS Illinois
Diversified Group Brokerage Corp
Comprehensive Benefits Co
Celtic Life Ins Co
BC/BS Missouri
BC of Philadelphia
Oxford Health Plan Mcare Risk
Diversified Pharmaceutical Svc
HIP Greater NY – Medicare Cost
HIP Greater NY – Medicare Risk
Caremark
Blue Preferred HMO (Utica)
Delta Dental
E1
E2
E3
E5
E7
EA
EB
EC
ED
EF
EJ
EM
ES
EV
Equicor
Employee Security Fund
Elm-Co Agency Inc
Express Scripts
BC/BS HMSA
Empire State Mutual Life Ins Co
Equitable Life Assurance Co
Emp Mutual Liability Ins Co of Wis
Equitable Life Ins Co of Iowa
Executive Life Ins Co of NY
Self Insured
Empire Plan/State Employees
Empire St Carpenters Wlfr Bnft Fnd
Envision Rx Options
F1
F2
F3
F5
F6
F7
First Fortis (Medical)
First Health
Corporate Health Administrators
Pan American Life
SNL Administrators
United Health Care
Page 6 of 13
Information for All Providers – Third Party Information
Ins Cd
F8
F9
FB
FC
FE
FF
FG
FH
FI
FJ
FK
FM
FN
FQ
FR
FU
Description
Vytra Health Care
First Cardinal
Farmer’s/Traders Live Ins Co
Fidelis Care
Fidelity and Casualty Co of NY
Fidelity Mutual Life Ins Co
Diversified Group Administrators
Fireman’s Ins Co of Newark NJ
Fireman’s Fund American Life Ins
Eastern Benefit Systems Inc
Excellus Rx
ECPA
Educator’s Mutual
EOCNC/Multiplan
Foundation Health Plan
United American Life Ins Co
G1
G2
G4
GA
GC
GE
GF
GG
GI
GJ
GK
GL
GN
GO
GW
GX
GZ
Group Administrators
Guardian Choice
BC/BS Georgia
Guardian Ins & Annuity Co Inc
Gerber Life Ins Co
Government Employees Health Assoc.
EPOCH Group
Govt Emp Life Ins Co NY (Union)
Assure Care
Guardian Life Ins Co of America
Genesee Valley Grp Hlth Plan (Roch)
Eye med Vision Plan
GuildNet Gold
FCE Benefit Administrator
Great West Life
Longview Fibre Self Insured
Medical Claims Service
H1
H3
H4
H8
HA
HB
HC
HE
HEM
HF
HG
HH
HI
HJ
HK
HL
HM
Hollow Metal Trust Fund
Argus Health Systems Rx
First Rehabilitation Life
Gallagher Bassett Service
HIP – Health Ins Plan of Greater NY
BCS Insurance Company
Health and Welfare Life Ins Assoc
Hartford Acc/Indem Co
Emblem Health
Hartford Life Ins Co
Magna Care
National Medical Health Card Systems
Home Life Ins Co
Health Plan Administrators
HealthFirst
Health Care Plan (Buffalo) – Univera
HIP of NJ
Version 2009-3
April 9, 2009
Ins Cd
HN
HQ
HS
HT
HU
HV
HZ
Description
Health Services Medical Corp
Health Economics Group
Healthways Inc
HealthPlus
Healthnet
Health Claim Services
Horizon Healthcare
IA
IB
ID
IF
IG
IH
IJ
IK
IL
IT
Int Life Investors Ins Co
Sun Life Financial
INDECS
Independent Health Assoc Inc
General American Life
Income Protection Policy-Inpt Assign
HMO CNY
BC Independence (PA)
Ideal Life Insurance Co.
ITT Life Ins Corp
J1
J2
J3
J4
J5
J8
JA
JB
JP
JU
JX
JJ Newman and Co
Justo Inc
Advantage Health Plan
North Americare
Phoenix Group Services
JLT Services Corp
JC Penney Ins Co
John Deere Ins Co
General Vision
GPA
Group Ins Service Center
K1
KC
KH
KM
KN
KO
Value Behavioral Health
BC/BS Kentucky
Keystone Health Plan East
BC/BS WNY Sr. Blue
ASO Health Plans
Integ Alternatives Comm Network
L2
LA
LB
LC
LD
LE
LG
LH
LI
LO
LW
Louisiana Office of Grp Benefits
Liberty Mutual Life Ins Co
Liberty Life Assurance Co
Lincoln National Life Ins Co/NY
APA Partners
Liberty Health Advantage
Lumbermans Mutual Ins Co
Teamsters Local 182 – Union
Life of America Ins Co
Local 1199 – Union
Harvard Pilgrim
M1
M3
The Maxon Co
McCrew Care
Page 7 of 13
Information for All Providers – Third Party Information
Ins Cd
M4
MB
MC
MD
ME
MED
MF
MG
MH
MHP
MI
MJ
ML
MM
MN
MP
MQ
MS
MT
MX
Description
BC/BS Montana
Mutual of Omaha Ins Co
Unicare
Medi-Plan
Mail Handlers Benefit Plan
MedBen
Medical Administrators
Metropolitan Ins and Annuity
Upstate Administration Svc
MetroPlus Health Plan
United Food Workers – Union
Monarch Life Ins Co
Montgomery Ward
Mutual Benefit Life Ins Co
Mutual Life Ins Co NY
Mutual Protective/Medico Life Ins Co
Mohawk Valley Physicians Hlth Plan
Milk Plant Emp Welfare Trust – Union
Mid-Hudson Health Plan
MGA Plan Administrators
N1
N2
N3
N4
N5
N6
N7
N8
NA
NB
NC
NCC
ND
NE
NF
NG
NH
NHP
NI
NJ
NK
NL
NM
NO
NR
NS
NT
NY
National Prescription Admin (NPA)
National Benefit Life Ins Co
National Prescription Svcs
NYS Auto Dealers Assoc
NY Farm Bureau/NYS BG
North Medical Comm Hlth Plan
National Assoc of Letter Carriers
Nassau Co Retiree Health Plan
NY Dental Svcs Group
NY School Athletic Protect/Plan
National Casualty Co
Northeast Community Care
NY Life Insurance Co
Nationwide General Ins Co
First Providian Life/Health Ins
Northcare Partners
Nippon Life Ins
Neighborhood Health Providers
National Ins Svcs Inc
Partners Health Plan
Nationwide Life Ins Co
New England Mutual Life Ins Co
Meritain Health
Nova Healthcare
Northwestern Nat Ins Co
New Hampshire/Vermont Health Svc
BC/BS of North Carolina
Health Scope Benefits Inc
OA
OB
Healthnow
HEREIU – Union
Version 2009-3
April 9, 2009
Ins Cd
OX
Description
Hotel Association of NYC
P1
P3
P5
P6
PA
PB
PC
PD
PE
PG
PI
PJ
PK
PL
PM
PO
PP
PR
PT
PU
PW
PY
Principal Mutual Ins Co
Pharm Serv Corp of NY (PSCNY)
HRA
Humana
Prudential
Paul Revere Life Ins Co
Phoenix Mutual Life Ins Co
Peerless Ins Co
Healthsource Inc
Penn General Srv of New England Inc
Pacific Care
IAA
IBOTV Health and Welfare Fund
Premier Health Network
Provident Life and Accident Ins
Provident Mut Lf Ins Co-Philadelphia
MEDCOHEALTH
Preferred Care
BS Pennsylvania
Pomco Ins
Premera Blue Cross of Washington
Physician’s Mutual
Q3
MDNY Healthcare
R1
R3
R4
RA
RB
RC
RD
RE
RG
RM
RX
RXA
Catalyst Rx
Equitable Plan Services
Harrington Benefit Services
Insurance Design Administrators
Insurance Management Services
International Benefit Administrator
Island Group Administration
Rochester Health Network
HIP Rutgers Health Plan of NJ
RMSCO Insurance
RX West
RX America
S1
SB
SD
SE
SG
SH
SL
SM
SO
SQ
SS
ST
BC/BS of South Carolina
Sieba Ltd
Susquehanna Administrators Inc
Sears Roebuck and Company
Security Mutual Life Ins Co
Sentry Life Ins Co of NY
St Lawrence/Lewis Schools Ins
Sanus Health Plan – Medicare Risk
Jockey Group Health Plan
State Farm Life and Accid Assurance
State Mutual Lf Assurance Co/America
Sterling Life Insurance Company
Page 8 of 13
Information for All Providers – Third Party Information
Ins Cd
SU
SV
SW
SX
SZ
Description
Assurant Employee Benefits
Security 65 Plan
Senior Whole Health
Sanus Health Plan
Suffolk Cty Employee Health Plan
T1
TA
TB
TC
TD
TE
TH
TL277
TP
TR
TU
BC/BS Texas
Teachers Ins and Annuity Trust-Union
Travelers
Transamerica Ins Co
Transworld Life Ins Co of NY
John Alden
Touchstone Health
Teamsters Local 277
Prime Therapeutics Pharmacy
Trademark
Travelers Health Network
U1
U2
U9
UA
UB
UC
UD
UH
UL
UN
UO
UP
Bakery and Confect Workers – Union
US Health Care – Medicare Risk
Industry Workers Local 424 – Union
Union Labor Life Ins Co
Union Mutual Life Ins Co
Key Medical/Regence Life
LMH Self Funded Medical Plan
United Mutual Life Ins Co
US Life Ins Co
Universal American
Utica Mutual Ins Co
Union Fidelity Life of PA
Version 2009-3
April 9, 2009
Ins Cd
VA
VC
Description
Veterans Aid
VNS Choice
W1
WA
WB
WF
WJ
WL
WM
WN
WP
WR
WS
WT
WV
Wachovia Insurance
Washington Nat Life Ins Co
Workers Comp
UMR
WJ Jones Admin Svcs
Westchester Gen Labor Welfare Fund
WalMart Self-Ins – Union
Walgreen’s Health
William Penn Ins Co of NY
Wellpoint Next Rx
Wassau (NY/NJ Wrkrs Cmp Claim Off)
Wellcare
BC/BS West Virginia
XR
United Concordia Co Inc
ZB
Zurich Insurance Company
Page 9 of 13
Information for All Providers – Third Party Information
Long Term Care Health Insurance Carrier Codes
The following are long term care (LTC) health insurance carrier codes:
Code
LTC01
LTC02
LTC03
LTC04
LTC05
LTC06
LTC07
LTC08
LTC09
LTC10
LTC11
LTC12
LTC13
LTC14
LTC15
LTC16
LTC17
Insurance Company
John Hancock Mutual Life Ins. Co
Genworth (Long Term Care)
Conseco: Bankers Conseco
AFLAC
American Progressive
Banker’s Life Insurance Company
Massachusetts Mutual Life Ins. Co.
CNA I & G
First Fortis
Travelers (Long Term Care)
MedAmerica
Metropolitan Life
TIAA: Metropolitan Life Insurance
Mutual of Omaha (Long Term Care)
New York Life
Prudential (Long Term Care)
Transamerica Life Insurance
Version 2009-3
April 9, 2009
Page 10 of 13
Information for All Providers – Third Party Information
Prepaid Capitation Plans (PCP)
Key:
Plan Type Abbreviation
Partial LTC
FHP
description
Long Term Care: Partial
Capitation
Long Term Care: PACE
Medicaid/Medicare
Advantage Plus
Physician Case
Management Program
Family Health Plus
SNP
Mainstream
Special Needs Plan
Medical Assistance
MA Advantage
Medicaid/Medicare
Advantage
LTC Pace
MA Adv Plus
PCMP
Model contract link
http://www.health.state.ny.us/health_care/managed_care/mltc/pdf/mltc_contract.pdf
http://www.health.state.ny.us/health_care/managed_care/mltc/pdf/pace_model_contract.pdf
http://www.health.state.ny.us/health_care/managed_care/mltc/pdf/map_model_contract.pdf
available upon request by calling the Bureau of Program Planning and Implementation at 518
473-0122
http://www.health.state.ny.us/health_care/managed_care/docs/medicaid_managed_care_and_
family_health_plus_model_contract.pdf
http://www.health.state.ny.us/diseases/aids/resources/snps/docs/entirecopy.pdf
http://www.health.state.ny.us/health_care/managed_care/docs/medicaid_managed_care_and_
family_health_plus_model_contract.pdf
http://www.health.state.ny.us/health_care/managed_care/docs/medicaid_advantage_model_co
ntract.pdf
Plan
Code
77
82
92
98
99
AN
Plan ID #
00798398
00477156
00894519
00313979
00313979
01750476
PCP Provider Name
Health Plus PHSP, Inc.
Affinity Health Plan, Inc.
Metroplus Health Plan, Inc.
HIP of Greater NY
HIP of Greater NY
Hebrew Home Hospital, Inc. (Co-op Care Plan)
AW
01898993
Homefirst, Inc.
C2
C7
01249265
01234037
HealthNow NY, Inc. (Community Blue)
Comprehensive Care Management Corporation
CG
CW
DC
DY
E4
E7
EF
FO
G3
GD
GH
GK
GN
H1
H4
HT
HW
HY
IE
IL
IN
IS
IX
01183013
01421250
01220373
01590830
01544090
01674982
02933315
01995440
01746212
01788325
02193608
02289090
01827572
02104369
02289090
00313979
01131584
01202822
01208997
01278899
01208997
01519162
01865329
Capital District Physician’s Health Plan
NYS Catholic Health Plan, Inc. (Fidelis)
United Medical Associates
Lourdes Primary Care Assoc. (Broome Max)
PCMP IIA Gold Choice
Senior Care Connection
NYS Catholic Health Plan, Inc. LPFHP
United Health Services Hospital
Bhard-Waj, Gaur MD (Broome Max)
Partners in Community Care
Group Health, Inc. PPO
GHI HMO Select A (UPS)
Guildnet
Senior Health Partners, Inc.
GHI HMO Select B (UPS)
HIP of Greater NY
HIP Westchester
HIP Nassau
Independent Health Association
Independent Living for Seniors
Independent Health Association
Loretto HMO
Independent Care Systems
Version 2009-3
April 9, 2009
Telephone Number
(718) 745-0030
(800) 553-8247
(800) 597-3380
(646) 447-5000
(646) 447-5000
(718) 379-5020
(888) 830-5620
(718) 630-2560
(877) 771-1119
(716) 887-6900
(718) 515-8600
(877) 226-8500
(716) 885-2261
(800) 749-0820
Plan Type
Mainstream
Mainstream
Mainstream
Mainstream
Mainstream
Partial LTC
Partial LTC
Mainstream
LTC Pace
(607) 778-2707
(716) 898-5968
(518) 382-3290
Mainstream
Mainstream
PCMP
PCMP
PCMP
LTC Pace
(607) 762-3173
(607) 770-0004
(845) 368-5943
(518) 446-8010
(518) 446-8055
(212) 769-6200
(212) 870-4610
(518) 446-8055
(646) 447-5000
(646) 447-5000
(646) 447-5000
(716) 631-3086
(585) 922-2836
(716) 631-3086
(315) 469-5570
(212) 584-2500
PCMP
PCMP
Partial LTC
FHP
Mainstream
Partial LTC
Partial LTC
Mainstream
Mainstream
Mainstream
Mainstream
Mainstream
LTC Pace
Mainstream
LTC Pace
Partial LTC
Page 11 of 13
Information for All Providers – Third Party Information
Plan
Code
KP
Plan ID #
01617894
PCP Provider Name
Amerigroup NY, LLC
KX
M3
M4
MO
MR
MV
MZ
N6
NW
OD
OG
OM
OZ
PH
SA
SF
02644562
01825947
02104350
01403176
00477023
01111375
01778523
02188296
01573739
02191582
02194003
02191362
01659989
01381319
00477183
01479670
Amerigroup Community Connections
Health Advantage Plans, Inc. (Elant Choice)
Addo, Samuel (Broome Max)
United HealthCare of NY, Inc. (Met Life)
Excellus
MVP, Inc. (Dutchess & Ulster Counties)
Senior Network Health, LLC
Total Aging in Place
NY Presbyterian Community PHSP, Inc.
VidaCare, Inc. SN
NY Presbyterian System Select Health SN
Metroplus Partnership Care SN
Univera
Southern Tier Priority HC
TotalCare (Syracuse PHSP)
HealthFirst PHSP, Inc.
SL
SP
SR
SY
TF
VC
WC
WH
WK
WN
WR
WU
Y2
Y4
Y8
Y9
YA
YC
YD
YG
YH
YM
YN
YQ
YR
YT
YW
YY
01746203
01751046
01746203
01143053
02710185
01750467
01182503
00477207
01799811
02825230
02367531
02825249
02581753
02591073
02594847
02660144
02588865
02707899
02738989
02942923
02932896
02922750
02914056
02801132
02872888
02902761
02645710
02802899
Saeed, Azmat MD
NYS Catholic Health Plan, Inc. (Fidelis)
Saeed, Azmat MD
Southern Tier Pediatrics PC
CCM Select
VNS Choice
Wellcare of NY, Inc.
Hudson Health Plan, Inc.
Broome County Max Program
Wellcare of NY, Inc.
Ramanujan Ramanujapuram
Wellcare of NY, Inc.
Neighborhood Health Provider, LLC
Group Health Inc.
Managed Health, Inc.
Liberty Health Advantage
Americhoice of NY
HIP Health Plan of NY
Fidelis Dual Advantage
GuildNet, Inc MAP M/M
Senior Whole Health M/M Plus
MetroPlus MA Advantage
VNS Choice Plus M/M
HealthNow of NY
Senior Whole Health
Touchstone HP (Prestige)
Wellcare of NYM/M
Affinity
Version 2009-3
April 9, 2009
Telephone Number
(800) 535-2814
(800) 563-5581
(212) 563-5570
(845) 569-0500
(607) 729-9327
(585) 454-1700
(518) 388-2427
(888) 355-4764
(716) 250-3100
(212) 297-5510
(212) 337-5180
(866) 469-7774
(212) 597-8600
(716) 857-4448
(607) 795-5215
(315) 476-7921
(800) 580-8540
(212) 801-6000
(607) 748-7355
(800) 749-0820
(607) 748-7355
(607) 734-3252
(718) 515-8600
(212) 609-5600
(800) 960-2530
(914) 631-1611
(607) 778-2702
(607) 723-1676
(212) 883-0883
(518) 446-8072
(212) 801-1638
(866) 542-4269
(212) 509-5999
(646) 447-6200
(718) 896-6500
(212) 337-5180
Plan Type
Mainstream
Partial LTC
Partial LTC
PCMP
Mainstream
Mainstream
Mainstream
Partial LTC
Partial LTC
Mainstream
SNP
SNP
SNP
Mainstream
PCMP
Mainstream
Mainstream
PCMP
Mainstream
PCMP
PCMP
Partial LTC
Partial LTC
Mainstream
Mainstream
PCMP
Partial LTC
PCMP
MA Adv Plus
MA Advantage
MA Advantage
MA Advantage
MA Advantage
MA Advantage
MA Advantage
MA Advantage
MA Adv Plus
MA Adv Plus
MA Advantage
MA Adv Plus
MA Advantage
MA Advantage
MA Advantage
MA Advantage
MA Advantage
Page 12 of 13
Information for All Providers – Third Party Information
County/District Codes
Below is a listing of all the counties and their corresponding district codes.
01
Albany
33
Orange
02
Allegany
34
Orleans
03
Broome
35
Oswego
04
Cattaraugus
36
Otsego
05
Cayuga
37
Putnam
06
Chautauqua
38
Rensselaer
07
Chemung
39
Rockland
08
Chenango
40
St. Lawrence
09
Clinton
41
Saratoga
10
Columbia
42
Schenectady
11
Cortland
43
Schoharie
12
Delaware
44
Schuyler
13
Dutchess
45
Seneca
14
Erie
46
Steuben
15
Essex
47
Suffolk
16
Franklin
48
Sullivan
17
Fulton
49
Tioga
18
Genesee
50
Tompkins
19
Greene
51
Ulster
20
Hamilton
52
Warren
21
Herkimer
53
Washington
22
Jefferson
54
Wayne
23
Lewis
55
Westchester
24
Livingston
56
Wyoming
25
Madison
57
Yates
26
Monroe
66
New York City
27
Montgomery
97
28
Nassau
Office of Mental Health
Administered
29
Niagara
98
Office of Mental Retardation
& Developmental Disabilities
30
Oneida
99
31
Onondaga
Breast & Cervical Cancer
Treatment Program
32
Ontario
Version 2009-3
April 9, 2009
Page 13 of 13