RCIPA Partners

RCIPA contracts with the following insurers and third party administrators to provide a network of physicians and allied health professionals to treat their Rochester-area members. As a RCIPA participating physician you participate in Aetna and Independent Health (non-HMO) plans (in the past these self-insured plans were referred to as "Doctors' Health Plan"). Please contact the RCIPA office if you have any questions regarding these lines of business.

Aetna | Independent Health


Aetna

reviewed September 2017

UPDATES


Aetna UAW Medicare Advantage Flyer: important information effective 1/1/2018

Aetna UAW Medicare Advantage Flyer


2017 Aetna / Rochester Regional Health System Medicare Update

Rochester Regional Health System is leaving the Aetna Medicare network. By now, you may have heard that effective January 1, 2017, Rochester Regional Health System (RRHS) will no longer be in the Aetna Medicare network. RRHS includes: Rochester General Hospital, Unity Hospital, Newark-Wayne Community Hospital, RRHS-employed providers and RRHS-owned provider practices/offices in the Greater Rochester area. For more information please refer to the 2017 Aetna / RRHS Medicare Update Letter.


Aetna acquired Coventry Health Care, Inc.

On May 7, 2013 Aetna acquired Coventry Health Care, Inc. Aetna and Coventry share a commitment to creating mutually beneficial relationships with providers. You do not need to take any action now. Keep working with Aetna and Coventry and servicing all of the patients as you always have been. No integration has taken place in NY yet, and no changes with your RCIPA contract as a result of the Coventry acquisition. We'll keep you updated as this new relationship progresses and let you know about future changes.


eviCore Preauthorization for Aetna members.

eviCore (formerly CareCore National) preauthorization for Aetna members is effective 04/01/2015. From 04/01/2015-04/07/2015, these authorization requests should be called into EviCore at 1-888-622-7329 Monday-Friday 7 am to 7 pm ET. After 04/07/2015, authorization requests may be called in or requested online at www.evicore.com available 24 hours per day, 7 days a week.

The following services require preauthorization:

For HMO/PPO and Medicare plans - effective 4/1/15:

For HMO and Medicare plans only - effective 4/1/15:

Additionally-effective 06/01/2015 for HMO/PPO and Medicare plans:


Counties: Genesee, Livingston, Monroe, Ontario, Orleans, Seneca, Wayne, Yates

Plans: Self-Insured Medical Plans (Aetna, UR Aetna), Student Health, Aetna Signature Administrators, Meritian, NY Signature, Aetna Medicare Advantage. For a complete list of participating Aetna plans: AetnaBenefitProducts.pdf.

Provider Services: 1-888-632-3862 / Aetna Medicare Provider Services: 1-800-624-0756
Payer ID: # 60054
Provider Website: Via Navinet | Navinet Telephone # 888-482-8057
Paper Claims: PO Box 981106, El Paso TX 79998-1106

Rochester-area Aetna Provider Representative: Lisa Thompson, thompsonl1@aetna.com, 585-329-0477

New Providers:

Formulary Information: Aetna Formulary
Clinical Policy Bulletins: Aetna CPB

As a RCIPA participating provider, you are credentialed by Aetna, but contracted through RCIPA.


Independent Health (non-HMO) / Nova Healthcare Administrators

reviewed December 2018

Counties: Genesee, Livingston, Monroe, Ontario, Orleans, Seneca, Wayne, Wyoming, Yates

Plans:

1 Article 43 Plans will have IHC Network on the member's ID card. A listing of the current IH Article 43 plans is shown below.

2 Self-Funded Plans will have id cards with self-funded services in the upper right hand corner of the card.

Independent Health (non-HMO)

Provider Services: 1-800-736-5771
Payer ID: # 95308
Provider Website: Independent Health
Paper Claims: PO Box 1017, Buffalo, NY 14231

Independent Health Article 43 Plans

✱Please call IH and confirm participation in the IHC network for the following plans- Flex Fit Active, Flex Fit Family , FlexFit Select.✱

Choice PlusChoice Plus Gold Choice Plus PlatinumChoice Plus Silver Copay HSAQChoice Plus Silver HSAQCitiGroup
Easy AccessEncompass Essential PlusEncompass Plus AEncompass Plus A PPOEncompass Plus BEncompass Plus B PPO
Encompass Plus B SelectEncompass Plus CEncompass Plus C PPOEncompass Plus DEncompass Plus D PPOEvolve
FEHB HDHPFEHB High OptionFEHB Standard OptionFlex Fit Active*Flex Fit Family*Flex Fit Select Active
Flex Fit Select FamilyFlexFit PlatinumFlexFit Platinum Copay NYS OONFlexFit Select*Healthy New YorkiDirect 1 Series
iDirect 2 SeriesiDirect 3 SeriesiDirect 4 SeriesiDirect 5 SeriesiDirect 6 Series iDirect Bronze Enhanced HSAQ
iDirect Bronze HSAQiDirect Bronze MViDirect Bronze MV HSAQiDirect Gold CopayiDirect Gold Copay HSAQiDirect Platinum
iDirect Silver BlendediDirect Silver Coinsurance HSAQiDirect Silver CopayiDirect Silver Copay HSAQiShare GoldiShare Platinum
Max GoldMax SilverNY PA GoldNY PA Silver HSAQPassport PlanPassport Plan Bronze HSAQ
Passport Plan Gold Passport Plan PlatinumPassport Plan SelectPassport Plan Silver HSAQStandard BronzeStandard Catastrophic
Standard GoldStandard PlatinumStandard SilverTraditional  

✱Please call IH and confirm participation in the IHC network for the following plans- Flex Fit Active, Flex Fit Family , FlexFit Select.✱

Nova Healthcare Administrators

Provider Services: Uniland & Northstar: 1-877-538-5501; all others: 1-800-999-5703
Payer ID: # 16644
Provider Website: Nova Healthcare Administrators
Paper Claims: PO Box 9050, Williamsville, NY 14231

Eligibility & Claims

Please use WNYHealtheNet: www.wnyhealthenet.org. Log onto the site and go to the Sign-Up tab at the top of the page and complete the form. Once you've completed the form, a representative from WNYHealtheNet will contact you to set up your account within 5 business days. You can also request a personal orientation session.

The following information is available on the site:

New Providers: Contact RCIPA by calling 585-454-1490 or via the Contact Form. Please provide the provider's name, specialty, NPI, tax ID, billing location address, service location address and you will be contacted within 48 hours.

Member ID Card: click here to view larger member id card.