Innovator Quality Bill Above Program

In recognition and appreciation for the pediatricians, internists, and family practice physicians who collaborate with us to provide superior care to our members, SOMOS Innovation has launched the Innovator Quality Bill-Above Program. Learn about changes to select billing codes here.

COVID 19 Vaccine Outreach and Counseling Program

The New York City Department of Health and Mental Hygiene has partnered with Medicaid and Medicare Advantage Health Plans to compensate providers who proactively reach out to eligible patients in their panel who are not vaccinated. The member must receive counseling regarding the importance of vaccination and assist with arranging vaccination. Once all steps are completed, providers may bill for a Counseling Visit. A counseling session may be provided by a licensed clinical provider (reimbursed $50 per counseling session) or

SOMOS Innovation Quality Corner

General Recommendations For Practices: Identify your patients at higher risk of ER visits, hospitalizations, and rehospitalizations due to chronic conditions. Educate patients to recognize symptoms of preventable events, empower them with self-management tools and make sure they are able to schedule follow-up appointments with their PCP. Inform patients about access to providers after hours (availability during evenings and weekends). Encourage patients to contact their PCP immediately upon feeling ill to avoid unnecessary ER visits. Ensure PCP staff is knowledgeable regarding

Electronic Data Interchange (EDI)

SOMOS Innovation partners with Empire Blue Cross Blue Shield and Emblem Health to support smooth claims/encounters processing. We encourage providers to submit claims electronically via Electronic Data Interchange (EDI) Payer IDs route EDI transactions to the appropriate payer. Please ensure you are using the corresponding Payor ID for Empire and Emblem listed below. Payer IDs must match the member’s health plan affiliation on the date of service or your claims will be rejected. New to EDI: If you are interested in

Targeting Social Needs Among New York’s Medicaid Population

Evolent collaborates with a Medicaid plan and nonprofit social services agency to support whole-person health. It’s no secret that the conditions in which people live can have an outsize influence on their health outcomes. Growing awareness of the impact of social determinants of health, such as access to safe housing, healthy food and transportation, has spurred greater interest for health care organizations, particularly Medicaid plans, to begin addressing them. Yet, recognizing needs and fulfilling them are two different things. Blanket

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