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Provider FAQs

Frequently Asked Questions

General

Who is HealthCare Partners (HCP)? How is HCP different from an insurance company or health plan?

HealthCare Partners (HCP) Independent Practice Association (IPA) is made up of more than 2,000 primary care providers (PCPs) and more than 5,000 specialists serving over 125,000 residents of New York, extending from Staten Island to Montauk, from Brooklyn to Westchester.

Founded over 20 years ago, HCP has grown to become the premier IPA in the New York Metropolitan Area. Our NY-based IPA is supported by the HealthCare Partners Management Services Organization (MSO) based in Garden City on Long Island, with nearly 250 staff members who offer clinical and administrative expertise to all of the HCP practices. By helping our practices, we let our doctors do what they do best – take care of patients.

Our goal at HCP is to foster an ever-stronger partnership with our providers and their patients through our commitment to transparency, communication and support. We exist to keep our providers independent so they can provide the best possible care to their patients. We do this by providing clinical and financial support and easing the administrative burden on our providers.

We are not an insurance company or health plan. We contract with insurance companies and health plans to support our providers in accessing the best coverage possible for their patients.

Providers and patients also benefit from our MSO support by gaining access to an array of programs and services such as Population Health, Case Management, Pharmacy, Member Advocate home visits, and Social Determinants programs and resources.

Is HealthCare Partners in New York affiliated with HealthCare Partners in California?

No.  HealthCare Partners of New York is an entirely separate organization and unrelated to HealthCare Partners in California.

What is the New Era at HealthCare Partners?

Over the last few months, the new HCP leadership team has heard from partners, providers, and staff on how we can best support our physicians.

In the rapidly changing healthcare market, we understand that our physicians need financial stability and security. We also understand that providers have choices in the marketplace. It is our mission to provide them with the best value. Our ultimate goal is to ensure that our physicians can remain independent so they can focus on providing the best care possible to their patients.

For the first time in over twenty years, we are a physician-led organization. This helps us to understand more intimately the pain points our providers face. In moving our organization forward, our leadership team is focused on establishing best practices and delivering positive changes that will improve the work and lives of providers and patients.

Our providers and their office staff will see significant progress in the coming weeks and months, starting with the launch of our new website and followed by the rollout of new claims and reimbursement processes and the launch of a new Provider Specialist Network (PSN),that includes more than 5,000 vetted specialists. We look forward to working hand-in-hand with you to implement these changes. We always welcome any thoughts on how we can continue to improve.

Our New Website

How will HCP’s new website www.HealthCarePartnersNY.com  help me?

The primary goal of our new site is to provide comprehensive, accurate and timely resources to our providers, and their patients. The site includes information and tools to help providers and staffs easily navigate to the resources they use every day.

Transparency is one of our key goals on this site. You will find information and tools more easily and readily available..

The new site will serve as a digital reference manual for our provider offices with step-by-step instructions on how to perform daily tasks all in one place.

Accessing HCP’s previous web address will redirect you to this site.

Can I submit Referrals through the HCP website?

Yes. Referrals are easily accomplished via the HCP website. You can also make Prior Authorization and Referral requests through our web based application: EZ-Net.

EmblemHealth Cohort 2

What is the difference between an HCP Direct provider and EmblemHealth Cohort 2 provider?

An HCP Direct provider has a direct contract with HCP. EmblemHealth Cohort 2 providers have a direct contract with EmblemHealth but are managed by HCP.

If I am an EmblemHealth Cohort 2 provider, how do I become an HCP Direct provider?

EmblemHealth Cohort 2 providers can take advantage of all the benefits available to HCP Direct providers by Joining our IPA.

If I become an HCP Direct provider, how is my membership in other IPAs impacted?

HCP is one of the only IPAs in the NY Metro Area that accepts full-risk payer contracts. As such, HCP allows participation with other IPAs but members of any full-risk contracts that HCP holds must remain with HCP. 

As an EmblemHealth Cohort 2 provider, why do I need to submit Notifications?

For EmblemHealth Cohort 2 providers, while a Referral is not required to visit specialists within the PSN, HCP requires Notification of each visit in order to ensure accurate payment is made by EmblemHealth.  While HCP provides the clinical and utilization management services for these patients, HCP does not pay the claims for EmblemHealth Cohort 2 patient care as it does for HCP Direct claims.

Prior Authorization Process

How will these changes, new processes and tools affect the authorization process?

HCP is focused on ensuring members have timely access to the care they need. By reducing the Prior Authorization requirements for services performed in office-based settings we expect more timely care and a decrease in the need for patients to access hospital-based services.

Will we need authorizations for every service?

Going forward, providers will not need Prior Authorizations for most office-based services, particularly those performed in an office-based setting versus a hospital. You will find more information on our Prior Auth Process page

What is the general timeframe for a Prior Authorization request?

HCP follows all federal, state and NCQA requirements in responding to requests for referrals, authorizations and claims payments.

Physicians

How will the changes at HCP help my practice stay independent and financially viable / increase revenue?

HCP is committed to helping PCPs optimize their revenue and earn incentive bonuses, and we have employees on staff to assist providers and their staffs. In addition, our support of CMS driven reimbursement enhancements in primary care will also increase PCP revenue while proving patient outcomes.

With the rollout of the new PSN, do my patients have to stop seeing the specialists they have previously seen? Can they maintain current relationships?

Engaging with these 5,000+ specialists will allow you and other HCP providers to provide the highest quality outpatient care to your patients.

As a PCP, you have the final say in who you refer your patients to. HCP has developed a pathway to facilitate access to the PSN providers to allow your patients to get the care they need without delay. However, Referrals and Authorizations Requests for care by non-PSN specialists can be submitted through this website.

Specialists

How do I know if I am part of the Preferred Specialist Network (PSN)?

All specialists in the PSN will be receiving communications notifying them that they have been selected to be a preferred specialist. If you are not sure if you are in the PSN, you can check at our PSN Tool.

What should a specialist know about EmblemHealth Cohort 2 providers?

HCP holds direct contracts with nearly 1,000 PCPs (HCP DIRECT providers) but works with an additional 1,000 PCPs in our EmblemHealth Cohort 2 network who hold contracts directly with EmblemHealth.

For PSN specialists providing care for EmblemHealth Cohort 2 patients, a Notification to HCP is required for each encounter in order to ensure accurate payments by EmblemHealth.