We are pleased to announce that Empire BlueCross BlueShield HealthPlus (Empire) has expanded its collaborative partnership with SOMOS IPA, LLC and its affiliates (SOMOS). This new agreement aligns incentives between the plan and SOMOS to deliver the highest possible quality care to our Medicaid Managed Care (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHPlus) and Essential Plan members in New York.

 

Effective October 1, 2020, for MMC, HARP, CHPlus and Essential Plan members in New York assigned to a SOMOS PCP, SOMOS will assume administrative functions including but not limited to: credentialing, population health management/transitional care management, utilization management and claims processing.

 

Prior authorization requests

Providers should contact SOMOS for prior authorizations at 1-844-990-0255.

 

Medical management

To obtain authorization or to verify member eligibility, benefits and account information, please call the telephone numbers listed on the back of the member’s ID card.

 

There are few different ID card layouts. Below is an example of one the ID cards. Other member’s ID cards may vary slightly from example below.

 


Claims processing

SOMOS encourages all claims to be submitted electronically using the below payer ID #s

SOMOS

81508

Paper claims submitted should be submitted to the following:

Attn: SOMOS IPA, LLC
PO Box 21432
Eagan, MN 55121

Please note:

  • SOMOS participating network providers must follow the claims protocols established by SOMOS as referenced in the provider’s participating provider agreement with SOMOS IPA.
  • Non-SOMOS participating network providers must continue to submit claims directly to Empire so that we may process the claims in accordance with your Empire contract.

 

Credentialing process

IPA providers: SOMOS will handle all credentialing for its participating providers. This includes submission of any demographic changes or terminations.

 

Non-IPA providers: Providers who are not contracted with the IPA must continue to follow the Empire processes.

 

If you have any questions, please contact Empire’s Provider Services department at 1-844-990-0255.

 

NYE-NU-0205-20 September 2020

 



Featured In:
October 2020 Empire Provider News