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New York Small Group Reference Guide 


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Customer Service and Vendors Presale Information Business Checklist Member Maintenance Plan Changes Carrier Appointment and BOR Procedures
 





 AetnaAtlantis Health PlanCIGNA HealthcareGHIHealth NetHealthPassOxford Health PlansPerfectHealth
Chiropractic
Outsourced to Triad
Atlantis does not outsource
Covered under Short Term Therapies
Not outsourced.
800-413-8695
Outsourced to Triad
Not outsourced.
Mental Health Vendor
Aetna Behavioral Health - 800-755-2422
24-Hour Nurse Help Line 800-556-1555
For Providers, call customer service.
For authorization, use the phone number on the ID card as service is based on residency address.
866-477-9740 or members can use http://www.atlantishp.com/search/index.asp 
CIGNA Behavioral Health :
New Jersey group members 800-715-0791--
New York 800-692-7311
Value Options is the vendor. Members can call the number on their ID card or in NYC subscribers can call 212-501-4444 and for other areas 800-624-2414. Providers may call 800-692-2489
MHN for NJ - 800-728-9899
MHN for NY - 800-583-2990
Carrier specific.
Oxford Behavioral Health 800-201-6991
Prescription Drug Vendor
Aetna Pharmacy Management 800-238-6279.
P.O. Box 398106, Minneapolis, MN 55439-8106
Mail Order 866-612-3862, ordering address: Aetna Rx Home Delivery, PO Box 417019, Kansas City, MO 64179-9892, or www.aetnarxhomedelivery.com
 
Rx claims forms and list of Pre Certification Rx are attached in our forms section. Carrier link: http://www.aetna.com/formulary/index.html#
Refer to our Rx reference guide in our forms section.
CatalystRx, 800-341-8570, www.catalystrx.com
For Rx benefits and pharmacy list, see: http://www.atlantishp.com/brokers/benefit_rx.asp
 
CIGNA  800-462-6633
 
Rx claim forms attached in our forms section.
For Pre Certification: www.cigna.com , then click on Drug List on left https://secure.cigna.com/health/form/drug_list.html
 Refer to our Rx reference guide in our forms section
ExpressScripts 877-415-9976.
Mail order www.express-scripts.com or 877-534-3682
Caremark for retail.  Health Net with any issues:  800-441-5741.
Mail order is from ExpressScripts, P.O. Box 52069, Pheonix, AZ 85072-9935. Customer Service 866-265-9458 or
 www.express-scripts.com
Formulary: https://www.healthnet.com/static/general/unprotected/pdfs/ne/pharmacy/formulary_info/alpha_tier_commercial.pdf Prior Authorization: https://www.healthnet.com/static/general/unprotected/pdfs/ne/pharmacy/formulary_info/commercial_pa_list_nj.pdf

Rx reimbursement forms are being changed. In the interim, send paid receipts with a cover letter and ID # to:
Health Net of the Northeast
Attn: Pharmacy Dept.
One Far Mill Crossing
PO Box 904
Shelton, CT 06484
Rx claim forms and Pre Authorization list are attached in our forms section.
Refer to our Rx reference guide in our forms section
All prescription plans must be the same for all offered plans. The exception is with products that have embedded Rx. There is a $2,000 maximum which is the wholesale cost of the Rx. Perfect Health has no Rx card as all their plans are H.S.A.
There is mandatory Mail Order for maintenance drugs.
Medco 800-905-0201 24 hours/7 days --
Rx Precertification - provider must call 800-753-2851, 8am-9pm EST.
 
Rx claim forms attached in our forms section.
Refer to our Rx reference guide in our forms section
 
Express Scripts is strictly a discount plan that only applies after deductible and coinsurance. Call 866-374-5543.
Mail order is available via www.express-scripts.com
Customer Service
Northeast Region: 888-287-4295
Options: #1-QPOS, HMO, HMO Dental Rider Plans, #2 PPO, Managed Choice,DMO/PPO/Indemnity Dental, Life or Disability, or #3 to speak to a representative.
For HSA plans call 800-594-9371.
Member maintenance 888-702-3862.
For HSA plans call 800-594-9371.
 
Mid-Atlantic Region: 888-287-4206
866-747-8422

Members: 800-244-6224

Group Related Issues: 800-603-0125 or email to hooksettunder50ua@cigna.com

New business submission queries: nesmallgroup@cigna.com 800-456-6575

Broker Services: In NY call 212-615-4037 and for outside NY call 800-552-0103.
Mail: Group Health Incorporated
Broker Services Dept.
441 Ninth Avenue, 7th Floor
New York, NY 10001
800-956-5565
Therapy Services: 800-413-8695
CareCore Radiology Management: 845-298-8155
888-313-7277
888-201-4216
Fax: 603-897-4543
OBM:
If you want to have the forms there ASAP you can email them to  obm@triveris.com.  
 
Some examples of the types of request that the mailbox can be used for include:
• Member additions & terminations
• Name or address change requests
• ID card requests
• Invoice requests
• Renewal letter requests
• General inquiries on group's coverage.
718-370-5380
Lab Vendor
Quest Diagnostics
 
Depends on the member zip code. Go to www.atlantishp.com, click on Find a Physician, Search for Ancillary, then Lab in the drop down specialty box and select.
Quest or LabCorp
 
There are several. Call customer service 212-501-4444.
Quest Diagnostics
NJ / NY: 800-631-1388
OOA PPO with Healthnet can use Labcorp or Quest as long as the lab vendor is listed on the First Health provider directory.  For example, member is located in Miami, Florida 33186.  When we ran the search for lab vendors on First Health on-line directory (below is the link),  both lab vendors came up.
The out of state national PPO on the left hand side of our network search page at HealthNet.com .  Here is the link directly: https://www.healthnet.com/portal/member/prvfinder/frameOutOfState.do?category=DoctorSearch&topic=outOfState
Carrier specific
LabCorp as of  January 1, 2007
Therapy Pre- Certification
OrthoNet Pre-Cerifies for North Jersey and Aetna Pre-Certifies for South Jersey.
OrthoNet does Pre-Certification.
Landmark does Pre-Certification.
OrthoNet does their Pre-Certification.