As of May 1, 2024, Elderwood Health Plan will be partnering with VNS Health’s Managed Long Term Care Plan in an exciting new relationship, under the name Elderwood IPA.

Elderwood Health Plan has chosen to enter into an agreement with VNS Health so that Elderwood’s Managed Long Term Care Partial Capitation Plan (“MLTCP”) members may transition to VNS Health MLTC.

Elderwood IPA is committed to supporting VNS Health as its local Western New York partner and positioned to serve additional VNS Health members in Erie, Genesee, Monroe, Niagara, Orleans, Chautauqua, and Wyoming counties in the future.

FAQs

• Q. Why is Elderwood Health Plan closing? 
  A. The 2023-2024 New York State Budget changed Public Health Law (HMH Part I) to require that all Managed Long Term Care Partial Capitation plans have an active Medicare Dual Eligible Special Needs Plan (D-SNP) by January 1, 2024. Elderwood Health Plan does not have an active Medicare Dual Eligible Special Needs Plan and has decided to enter into an agreement with VNS Health, which has an active D-SNP.  

• Q. Why is the state of New York doing this?  
  A. The NYS Department of Health’s priority is integrated benefits for Medicaid members who also have Medicare.  Managed Long Term Care Partial Capitation plans, such as Elderwood Health Plan that do not have an aligned Medicare Advantage plan, called a Dual Eligible Special Needs Plan (D-SNP), cannot offer such an integrated benefit in our Partial Capitation plan to our members. 

• Q. Is Elderwood Health Plan going out of business? 
  A. Elderwood Health Plan remains fully committed to its mission and to the communities it serves. Elderwood Health Plan has decided that it will no longer operate its MLTC plan and members enrolled in Elderwood’s MLTC will transfer to VNS Health MLTC. Elderwood has formed an independent practice association, Elderwood IPA, LLC, which will perform care management for certain VNS Health members, on behalf of VNS Health. 

For Members

In order to make this transition and your experience as seamless as possible, Elderwood members who move to VNS Health will continue to have their Elderwood care manager.

New York Medicaid Choice, the State’s MLTC enrollment broker, has sent a letter to all Elderwood Health Plan members telling you about the change.

If you would like to speak directly to New York Medicaid Choice regarding MLTC enrollment, or your plan options, please call New York Medicaid Choice at 1-888-401-6582 (TTY: 1-888-329-1541). Monday – Friday, 8:30 am – 8:00 pm, Saturday, 10:00 am – 6:00 pm.

You can learn more about VNS Health and VNS Health MLTC at www.vnshealthplans.org. You can also contact VNS Health at 888-867-6555 (TTY: 711).  You can call Monday to Friday, from 9:00am to 5:00pm.

For Providers

VNS Health has delegated Elderwood IPA to serve as our Western NY provider relations liaison. Elderwood IPA will manage provider relations, credentialing and conduct site visits.

For Elderwood IPA Provider relations department, and any claim inquiries or disputes prior to May 1, 2024, please call 1-866-843-7526.

For claim status questions, disputes, and claim inquiries for services served on or after 5/1/2024, contact VNS Health at 1-866-783-0222.

Provider FAQs

• Q: What is the correct payer ID for submitting an electronic claim for VNS for services post 5/1?
  A:

Date of Service	Electronic Claim Submissions Payer ID
On or after 5/1/2024	77073 (Fee For Service or Encounter)

• Q: If we are unable to submit an electronic submission, what is the correct paper submission address?
  A: For hard copy (paper) submissions:
  VNS Health
  Health Plans
  P.O. Box 4498
  Scranton, PA 18505

• Q: How do I submit a new authorization request after 5/1/24?
  A: Effective 5/1/2024, new prior authorization requests (and all applicable documentation) may be submitted to VNS Health via:

• Provider Portal: vnshealthplans.org/provider-portal
  • Fax: 212-897-9448
  • Phone: 1-866-783-0222

Please note providers must continue to provide care for one hundred twenty (120) days following the 5/1/24 transition, or until the enrollee’s new plan has conducted an assessment and the member has agreed to a new plan of care, in accordance with the member’s existing plan of care. This means that there will be no change in the type or level of services currently provided, and the provider will continue to be compensated at the rates set forth in the Participating Provider Agreement.