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Working with CDPHP

Important Notices for Providers Working with CDPHP

DEA Warns of Extortion Scam

The Drug Enforcement Administration (DEA) wants you to be aware of extortion scams targeting DEA registrants. Criminals are calling physicians and other registrants, and identifying themselves as DEA employees or other law enforcement officials. These criminals are demanding money or threatening to suspend your registration.

The criminals mask their phone number on caller ID so the display shows the DEA registration support 800 number. The DEA emphasizes that a real DEA employee would never contact you seeking money or threatening to suspend your registration.

If you are contacted by a person claiming to work for the DEA and asking for money or making threats against your registration, report the call via the DEA Extortion Scam Online Reporting tool.

If you have any questions related to the security of your information at CDPHP, please email us at

Prior Authorization Changes

CDPHP is pleased to announce upcoming changes that will reduce administrative burden and make it easier to get your job done. Effective January 1, 2019, eviCore will no longer provide advanced radiology administration for CDPHP. In fact, we are removing the prior authorization requirement for all high-tech radiology testing. Learn more.

2018 Commercial and Medicare Benefit Changes
CDPHP is introducing new plans and benefit enhancements to improve our commercial and Medicare members' experience in the coming year. For your convenience, we've prepared a summary of the changes that you and your staff can use as a reference. For more information about a specific member's benefits, please log in to your account.

Magellan Leadcare and Leadcare II Equipment Update
This past June, the FDA posted a notice on its medical device recall website stating that Magellan Diagnostics is expanding a recall to include LeadCare and LeadCare II Systems. Magellan clarified that the recall is part of the earlier FDA Safety Notification, which included all four LeadCare Blood Lead Testing Systems when used with venous blood, and is not a new recall. They also stated that these products are not being removed from the field, but rather customers are being asked to discontinue use of venous blood with Leadcare Testing Systems. Find out more.

Please Attest to Your CMS Compliance Status
As a health plan that contracts with CMS to offer Medicare Advantage coverage, CDPHP is required to have a compliance program to prevent, detect, and correct non-compliance with CMS program requirements. All participating provider practices should also be assuring that their staff and physicians adhere to all applicable laws and regulations that govern the program.

Through the Medicare Learning Network®, CMS offers standardized online provider training on Medicare Parts C & D Fraud, Waste, and Abuse (FWA) and General Compliance. CDPHP also offers an online provider training to assist you in achieving compliance.

CDPHP Medicare Compliance Training for Providers, Practitioners, and Facilities - 2019

If you do not already have a CMS compliance training process in place, please assure that all staff view the above compliance presentation within 90 days of first hire and at least annually thereafter. At the end of the presentation is an attestation form and tracking tool that you can use to document each employee’s completion of the training. This documentation should be retained for 10 years and made available upon request by CDPHP or CMS.

New LARC Guidelines
Effective immediately, providers are eligible to bill for long-acting reversible contraceptives (LARC) for CDPHP Commercial, Select Plan/HARP, or Child Health Plus members when the service is provided during an inpatient stay. This is subject to contractual limitations and/or parameters established in any employer-sponsored summary plan description and/or benefit design document. Providers should follow NYS billing practices to receive reimbursement. More information is available on the DOH website.

CDPHP Holiday Schedule
CDPHP business areas process non-inquiry files Monday through Friday. Files may be submitted 24 hours a day, seven days a week, 365 days a year. Files received after 2 p.m. EST will be processed the next business day. CDPHP does not process claims on the following days:

  • Saturday
  • Sunday
  • New Year’s Day
  • Presidents Day
  • Memorial Day
  • Independence Day
  • Labor Day
  • Thanksgiving
  • Friday following Thanksgiving
  • Christmas Eve Day
  • Christmas Day

Enroll as a Medicare Provider by January 1, 2019
CMS is requiring nearly all providers (dentists, physicians, psychiatrists, residents, nurse practitioners, and physician assistants), including Medicare Advantage providers, who prescribe drugs for Part D patients to enroll in Medicare (or validly opt out, if appropriate) by January 1, 2019. CDPHP will be required to deny coverage for drugs prescribed by providers who are not enrolled in (or opted out of) Medicare, except in limited circumstances, after this deadline. Learn more.

Out-of-Network Law
New York state law requires doctors and hospitals to more clearly communicate their health plan affiliations to patients. Find out more.

Help Us Protect Victims of Domestic Abuse

New York State laws and regulations spell out steps CDPHP must take to assure the privacy of covered dependents who have: 1.) a valid order of protection against the policyholder or another insured covered under their insurance policy; or 2.) made a request to CDPHP to receive communications at an alternate address or via alternate means. Interacting with their providers of care is one of the most effective means for victims of domestic violence to learn about their rights. Read more about the legislation referenced above and print copies of a member notice that CDPHP has prepared for our network providers to post in their office.

Enhanced Managed Care for HARP Members

In anticipation of the transition of all behavioral health benefits to mainstream Medicaid managed care and the implementation of HARP, Capital District Physicians’ Health Plan, Inc. (CDPHP®) partnered with Community Care Behavioral Health (CCBH) to provide enhanced care management strategies for HARP members. The following are some of the frequently asked questions posed by health homes and their downstream care management agencies (CMAs).