RCIPA Group Participation and Provider Enrollment (Instructions and Forms)
The Rochester Community Individual Practice Association (RCIPA) is an organization which manages a healthcare provider network of approximately 4,000 physicians and allied health professionals who practice in the New York State counties of Genesee, Livingston, Monroe, Ontario, Orleans, Seneca, Wayne, Wyoming and Yates. Formed in 1984, RCIPA remains dedicated to maintaining a community-wide panel of health care professionals to provide high quality, cost-effective and accessible health care for residents of the Greater Rochester Area. RCIPA contracts with insurers and third party administrators (TPAs) on behalf of its participating organizations and their individual healthcare providers. All RCIPA providers participate in RCIPA's contracts with Independent Health (non-HMO) / Nova Healthcare. The majority of RCIPA members also participate in the RCIPA-Aetna network through RCIPA's contract with Aetna.
☞ Note: solo-practitioners are considered an organization for contracting purposes and an individual for enrollment/credentialing purposes so Sections 1 and 2 apply to solo-practitioners.
SECTION 1 New Healthcare Organization (Practice/Group) Joining RCIPA
☞ This section also applies to existing participating orgainzations (practice/group) that change their tax identification number (TIN)
RCIPA contracts with medical practices, solo practitioners, hospital systems, health clinics and other healthcare organizations that engage under the organization's tax identification number ("TIN") individual healthcare providers in rendering healthcare services to enrollees/patients covered by one of RCIPA partners (Aetna, Independent Health and POMCO); for more information on RCIPA's partners click here.
The RCIPA Participation Agreement is a single-signature agreement between RCIPA and the legal owner(s) of the organization ("Contracting Entity") that enables the organization's individual healthcare providers to render healthcare services to RCIPA's partners's enrollees/members under the TIN of the Contracting Entity according to the terms of the Agreement.
INSTRUCTIONS: To become a RCIPA participating practice/group please complete the RCIPA Participation Agreement and an IRS W-9 for the TIN of the Contracting Entity (the TIN can either be an EIN or SSN). Please return the Signature Page ONLY of the RCIPA Participation Agreement and the W-9 Form to RCIPA either by emailing the forms to firstname.lastname@example.org (or directly to the RCIPA staff person you are working with) or faxing the forms to 585-287-9982. Once RCIPA has processed the Agreement an executed copy of the signature page shall be returned to the organization. If there are any questions pertaining to the Agreement please contact RCIPA at email@example.com or contact the RCIPA staff person you are working with.
The RCIPA Participation Agreement Master Packet contains all the materials needed to become a RCIPA participating organization and to enroll physician/allied health providers and NPPAs.
RCIPA Participation Master Packet (includes RCIPA Participation Agreement, W-9, Provider Information Sheet, RCIPA-Aetna Addendum and NPPA Form)
Please Note: The RCIPA Participation Agreement is ONLY applicable to a single TIN. If an organization has multiple TINs then a separate Agreement is required for each TIN and individual healthcare providers must be enrolled separately under each TIN.
Please Note: The RCIPA Participation Agreement is NOT transferable to another TIN. If an organization for whatever reason changes its TIN then a new Agreement is required for the new TIN and the associated individual healthcare providers will need to be enrolled under the new TIN.
☞ The next step after completing the RCIPA Participation Agreement is to complete the necessary paperwork for the individual healthcare providers (the organization's roster of providers) that will be billing under the Contracting Entity's TIN. Instructions for adding individual healthcare providers to the organization are in Section 1 and Section 2 below ⇓.
SECTION 2 ENROLLMENT Physician, Allied-health Professional, Certified Nurse Midwife etc. with RCIPA
☞ The provider enrollment process applies to both new organizations joining RCIPA and existing RCIPA participating organizations.
☞ The provider enrollment forms apply to both community-based providers and hospital-based providers.
Physicians (MD/DO), allied health professionals, Psychiatric Nurse Practitioners, Certified Nurse Midwives (CNM) and Family Nurse Practitioners (FNP) that serve as independent Primary Care Providers (PCPs) are eligible to enroll with RCIPA as participating providers under a RCIPA participating practice/group.
INSTRUCTIONS: Providers must have an up-to-date (current CAQH attestation) CAQH ProView® that reflects the provider's current practice information for the practice/group the provider is enrolling under. Providers that are enrolling under a RCIPA participating practice/group that participates with Aetna through RCIPA must complete a RCIPA-Aetna Individual Provider Addendum. Please return the RCIPA Provider Information Sheet and the RCIPA Individual Provider Addendum (if applicable) to RCIPA either by emailing the forms to firstname.lastname@example.org (or directly to the RCIPA staff person you are working with) or faxing the form(s) to 585-287-9982. If there are any questions pertaining to adding a provider to a RCIPA participating practice/group please contact RCIPA at email@example.com or contact the RCIPA staff person you are working with.
Community-based healthcare providers enrolling with RCIPA and participating with Aetna through RCIPA that are not currently Aetna credentialed in New York State must complete the Aetna online application (the Aetna online application is linked below).
Please Note: The Aetna credentialing process takes approximately ninety (90) days to complete therefore it is imperative RCIPA receive provider enrollment materials as early as possible to ensure the provider is Aetna credentialed prior to the provider starting with the practice/group. A provider will not be considered eligible to submit Aetna claims under a RCIPA participating practice/group until the provider has been assigned an effective date for that particular practice/group; in other words claims submitted by a provider prior to the Aetna effective date will neither be governed by the RCIPA Participation Agreement nor covered by the RCIPA-Aetna fee schedule.
☞ Aetna medical speciality-specific notes
Please Note: Licensed Mental Health Counselors (LMHC) are not eligible to participate with Aetna through RCIPA and must apply to Aetna through Aetna Behavioral Health Network (ABH 1-800-999-5698).
Please Note: Chiropractors are not eligible to participate with Aetna through RCIPA—please call Aetna Providers Services at 1-888-632-3862 for assistance. Chiropractors are still eligible to enroll with RCIPA for other plans and products offered by RCIPA's partners.
Please Note: Optometrists are eligible to participate with Aetna through RCIPA if the provider is joining an existing RCIPA participating organization or medical practice that participates with Aetna through RCIPA else the provider must go through EyeMed Vision Care 1.888.581.3648.
Please Note: Aetna accepts Registered Dieticians and Nutritionists through RCIPA but Aetna does not enroll Certified Diabetic Educators through RCIPA unless the provider is also a Registered Dietician and therefore would be enrolled with Aetna through RCIPA.
SECTION 3 ENROLLMENT NPPA (nurse practitioner / physician assistant / mid-levels) with RCIPA
☞ The NPPA enrollment process applies to both new organizations joining RCIPA and existing RCIPA participating organizations.
INSTRUCTIONS: to enroll a mid-level provider please email the below mid-level provider information to firstname.lastname@example.org or fax to 585-287-9982. Please use the format displayed below.
Please Note: Psychiatric Nurse Practitioners and Certified Nurse Midwives (CNM) and Familiy Nurse Practitioners (FNP) that serve as independent Primary Care Providers (PCPs) should follow SECTION 2 above ⇑.
Mid-Level name (first, middle, last)
Mid-Level title (NP, PA, CRNA etc.)
Mid-Level DOB (mm/dd/yyyy)
Mid-Level New York State license # and expiration date
Mid-Level individual NPI # (10 digits)
Mid-Level CAQH PIN # (eight digits)
TIN (9 digit tax identification #)
TIN legal name
Mid-Level effective date with the TIN
Billing address (street, city, state, zip, telephone #)
Practice address (street, city, state, zip, telephone # and fax #)
Practice name (group name, department name, DBA etc.): this aids RCIPA and Aetna in logically grouping providers in the RCIPA and Aetna systems.
Mid-Level role (primary care or specialist, i.e. what type of services does the mid-level provide at the practice location); for shorthand role = P or role = S will suffice.
Please Note: It takes Aetna approximately thirty (30) days to process a NPPA therefore it is imperative RCIPA receive NPPA enrollment requests as early as possible to ensure the NPPA is loaded into the Aetna system prior to the NPPA starting with the practice/group. A NPPA will not be considered eligible to submit Aetna claims under a RCIPA participating practice/group until the NPPA has been assigned an effective date for that particular practice/group; in other words claims submitted by a NPPA prior to the Aetna effective date will neither be governed by the RCIPA Participation Agreement nor covered by the RCIPA-Aetna fee schedule.