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
reviewed October 2020
UPDATES
Aetna Medicare Advantage & Rochester Regional Health Reminder
Effective January 1st, 2020, Rochester General Hospital, Newark Wayne Community Hospital and Unity Hospital and their associated employed physicians and healthcare providers will be participating in Aetna's Medicare Advantage products in addition to the Aetna commercial plans and products Rochester Regional Health physicians and healthcare providers are already participating with.
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. There are no changes with your RCIPA contract as a result of the Coventry acquisition. We'll keep you updated 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. These authorization requests should be called into EviCore at 1-888-622-7329 Monday-Friday 7 am to 7 pm ET or requested online at www.evicore.com available 24 hours per day, 7 days a week.
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: Aetna | Availity 1-800-AVAILITY (282-4548)
Paper Claims: PO Box 981106, El Paso TX 79998-1106
Aetna ERA, EFT & Electronic EOBs: Information and links.
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.
Ensure provider has completed a CAQH application: CAQH.
Complete the Aetna Medical Application Request to allow Aetna to add provider to the Aetna CAQH roster and to access the provider's CAQH application: Aetna Medical Application Request
Credentialing typically takes 60 business days once Aetna has received all required and up-to-date credentialing materials. Aetna will send you a letter with the provider's Aetna PIN number. For a provider's credentialing status, you may call the Aetna Main Credentialing line at 1-800-353-1232.
Dentists aside from oral maxillofacial surgeons generally do not participate with Aetna through RCIPA. RCIPA participating medical practices that have dentists on staff should contact Aetna Dental at 1-800-451-7715 regarding dental provider enrollment.
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 2019
Counties: Genesee, Livingston, Monroe, Ontario, Orleans, Seneca, Wayne, Wyoming, Yates
Plans:
- Non-HMO Plans (Article 431 and Self-Funded Plans 2)
RCIPA providers do NOT participate in Independent Health HMO plans but may see HMO members with an authorized out of area referral
RCIPA providers do NOT participate in Independent Health Medicare Advantage, Medicaid or NYSHIP 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.✱
Passport Plan Local Gold HSAQ
Passport Plan Local Bronze HSAQ
Standard Healthy NY Gold
iDirect Silver Blended HSAQ
iDirect Bronze Coinsurance HSAQ
iDirect Bronze Blended HSAQ
FlexFit Platinum OON
Citibank North America
iShare Platinum
iShare Gold
iDirect 6 Series
iDirect 5 Series
iDirect Silver Blended
iDirect Bronze Enhanced HSAQ
FEHB HDHP
FEHB High Option
FEHB Standard Option
Choice Plus
Choice Plus Gold
Choice Plus Platinum
Choice Plus Silver HSAQ
Easy Access
Encompass Essential Plus
Encompass Plus A
Encompass Plus B
Encompass Plus C
Encompass Plus D
Evolve
Flex Fit Active*
Flex Fit Family*
Flex Fit Select Active
Flex Fit Select Family
FlexFit Platinum
FlexFit Select*
Healthy New York
iDirect 1 Series
iDirect 2 Series
iDirect 3 Series
iDirect 4 Series
iDirect Bronze MV
iDirect Gold Copay
iDirect Gold Copay HSAQ
iDirect Platinum
iDirect Silver Coinsurance HSAQ
iDirect Silver Copay
iDirect Silver Copay HSAQ
Max Gold
Max Silver
NY PA Gold
NY PA Silver HSAQ
Passport Plan
Passport Plan Select
Standard Bronze
Standard Catastrophic
Standard Gold
Standard Platinum
Standard Silver
Traditional
iDirect Bronze MV HSAQ
Encompass Plus B Select
Encompass Plus D PPO
Encompass Plus A PPO
Encompass Plus B PPO
Encompass Plus C PPO
Passport Plan Local Platinum
Passport Plan Local Silver HSAQ
Passport Plan National Bronze HSAQ
Passport Plan National Gold HSAQ
Passport Plan National Platinum
Passport Plan National Silver HSAQ
Activate Gold
✱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: HEALTHeNET. 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:
Patient eligibility, plan name, primary care/OBGYN (if applicable), members demographic information, some coordination of benefits information (if applicable)
Patient cost share information for select list of benefits
Patient accumulator information for deductible and out-of-pocket maximums
Claim status
Authorization inquiry
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.
