Resources for Physicians & Hospital Administrators
Provider Manuals
GHI Provider Manual
Services covered, claims processing requirements, electronic funds transfer, whom to contact with questions regarding any aspect of your participation.
Services covered, claims processing requirements, electronic funds transfer, whom to contact with questions regarding any aspect of your participation.
GHI HMO Provider Manual
Services covered, claims processing requirements, electronic funds transfer, who to contact with questions regarding any aspect of your participation.
Services covered, claims processing requirements, electronic funds transfer, who to contact with questions regarding any aspect of your participation.
GHI Medicare Choice PPO Provider Manual
This comprehensive guide highlights key features and detailed information about the program.
This comprehensive guide highlights key features and detailed information about the program.
PDF
Behavioral Health Provider Manuals
Tip Sheets
GHI HMO Government Programs Provider Reference Sheet
Your fast, easy-to-use reference for GHI HMO Medicaid, Family Plus and Child Health Plus programs.
Your fast, easy-to-use reference for GHI HMO Medicaid, Family Plus and Child Health Plus programs.
PDF
GHI Medicare Choice PPO Provider Tip Sheet
Your fast, easy to use reference for information and numbers related to Medicare claims.
Your fast, easy to use reference for information and numbers related to Medicare claims.
PDF
High Deductible Health Plan (HDHP) Tip Sheet
To meet the growing demand for consumer-directed health care, GHI has developed HDHPs, effective April 1, 2006.
To meet the growing demand for consumer-directed health care, GHI has developed HDHPs, effective April 1, 2006.
PDF
Guidelines and Procedures
GHI's Medical Policies and Clinical Practice Guidelines
Review GHI's medical necessity criteria for specific procedures, services and technologies.
Review GHI's medical necessity criteria for specific procedures, services and technologies.
GHI Hospital Claim Processing Codes
GHI's criteria for claims adjudication, and suggestions on how to reduce returned claims.
GHI's criteria for claims adjudication, and suggestions on how to reduce returned claims.
Policies, Procedures and Reference Materials for Medicaid and Family Health Plus Providers
GHI HMO's Medicaid Contract with the New York City Department of Health, as well as reference materials for Medicaid and Family Health Plus providers.
GHI HMO's Medicaid Contract with the New York City Department of Health, as well as reference materials for Medicaid and Family Health Plus providers.
GHI Diagnostic Imaging Management Program
All participating providers are required to comply with this program, administered by CareCore National, LLC.
All participating providers are required to comply with this program, administered by CareCore National, LLC.
NYS Department of Health Standard Clauses Appendix
All GHI HMO participating providers are required to comply with this appendix.
All GHI HMO participating providers are required to comply with this appendix.
Domestic Abuse Guidelines for Health Care Professionals
Physicians and other health care professionals are well positioned to respond to cases of domestic violence because of their consistent relationship with patients and the trust that the patients often have in their doctors.
Physicians and other health care professionals are well positioned to respond to cases of domestic violence because of their consistent relationship with patients and the trust that the patients often have in their doctors.
HIPAA Information for Providers
GHI wants to ensure that you have a clear understanding of the requirements associated with HIPAA (Health Insurance Portability and Accountability Act).
GHI wants to ensure that you have a clear understanding of the requirements associated with HIPAA (Health Insurance Portability and Accountability Act).
ADA Checklist
Ensure that you are in full compliance with Section 504 of the Rehabilitation Act of 1973 and Title II of the Americans with Disabilities Act of 1990.
Ensure that you are in full compliance with Section 504 of the Rehabilitation Act of 1973 and Title II of the Americans with Disabilities Act of 1990.
PDF
Electronic Claims Submission and EFT
Online EFT Enrollment
Log in the GHI.com for providers to securely set up EFT for your practice. Once logged in:
Click on Provider Profile
Then click on GHI-EFT
You will be prompted for all the information you will need to provide.
Log in the GHI.com for providers to securely set up EFT for your practice. Once logged in:
You will be prompted for all the information you will need to provide.
Medical and Hospital Electronic Media Claims Submission
A fast, paperless way to submit claims, leading to faster reimbursement to you. Reduces your clerical time, processing and mailing costs.
A fast, paperless way to submit claims, leading to faster reimbursement to you. Reduces your clerical time, processing and mailing costs.
Tools and Services
Check Status of Inpatient Stays by Phone
This automated phone service lets you check requests for inpatient authorizations or extensions.
This automated phone service lets you check requests for inpatient authorizations or extensions.
AnswerLine
This automated touch-tone telephone system can be accessed 24/7 for information and assistance.
This automated touch-tone telephone system can be accessed 24/7 for information and assistance.
Patient Safety
Information about patient safety and prevention of medical errors, plus quality-of-care guidelines and tools.
Information about patient safety and prevention of medical errors, plus quality-of-care guidelines and tools.
RelayHealth® - Consult Patients Online
Reimbursable and secure way to connect with your patients online
Reimbursable and secure way to connect with your patients online
Resources and Phone Numbers
GHI Phone Numbers and Addresses
- Contract, Product or Fee Schedule inquiries
- Customer Service, Inpatient Stay, Provider Directory and Coordinated Care inquiries
- Contract, Product or Fee Schedule inquiries
- Customer Service, Inpatient Stay, Provider Directory and Coordinated Care inquiries
Behavioral Health Consultation Line/ValueOptions Referral Phone Numbers
A toll-free PCP consultation line for telephone consultation on mental health and substance abuse treatment, including medications.
A toll-free PCP consultation line for telephone consultation on mental health and substance abuse treatment, including medications.
Prescription Drugs
Pharmacy benefits are administered by either Express Scripts, Inc. or GHI Pharmacy Services. The name and phone number of your patient's PBM is listed on your patient's GHI ID card.
| Pharmacy Managed by Express Scripts |
Pharmacy Managed by GHI or GHI HMO Pharmacy Services |
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Additional Information and Tools
Behavioral Healthcare (HMO)
Working collaboratively, GHI HMO, Merit Behavioral Care Corporation (an affiliate of Magellan Behavioral Health) can ensure that members are receiving specialized attention for their behavioral health care needs.
Working collaboratively, GHI HMO, Merit Behavioral Care Corporation (an affiliate of Magellan Behavioral Health) can ensure that members are receiving specialized attention for their behavioral health care needs.
False Claims Act and Medicaid Fraud Programs
Medicare Part D and the Deficit Reduction Act of 2005 require carriers to provide information to contractors and agents, including providers, about certain laws related to fraud and abuse.
Medicare Part D and the Deficit Reduction Act of 2005 require carriers to provide information to contractors and agents, including providers, about certain laws related to fraud and abuse.
Occupational Health Clinic (HMO)
Information on GHI's responsibility for Eastern New York Occupational and Environmental Health Center (ENYOEHC), and when you might consider an occupational medicine referral for your patients.
Information on GHI's responsibility for Eastern New York Occupational and Environmental Health Center (ENYOEHC), and when you might consider an occupational medicine referral for your patients.
Alcohol Abuse Screening Tool
Screening tool and clinical guidelines for patients with alcohol use disorders.
Screening tool and clinical guidelines for patients with alcohol use disorders.
Depression Screening Tool
Screening tool and clinical guidelines for patients suffering from depression.
Screening tool and clinical guidelines for patients suffering from depression.
Colorectal Cancer Screening: A Practical Guide For Health Insurance Plans
Tools and strategies to increase colorectal cancer screening rates, from The American Cancer Society.
Tools and strategies to increase colorectal cancer screening rates, from The American Cancer Society.
Information Regarding Potentially Inappropriate Medications in Older Adults
An education/management tool from The New York State Patient Safety Enhancement Committee, to help practitioners reduce inappropriate medication use in older adults.
An education/management tool from The New York State Patient Safety Enhancement Committee, to help practitioners reduce inappropriate medication use in older adults.
GHI Supports AHIP Online Course on Cross-Cultural Care
This free continuing medical education course is designed to provide physicians with the tools and skills to effectively communicate with patients from diverse backgrounds.
This free continuing medical education course is designed to provide physicians with the tools and skills to effectively communicate with patients from diverse backgrounds.
GHI Sponsors Providers in NCQA Developed Recognition Programs
Participate in special recognition programs from The National Committee for Quality Assurance (NCQA).
Participate in special recognition programs from The National Committee for Quality Assurance (NCQA).
2005 National Healthcare Disparities Report
Tracks disparities in quality of and access to health care in the U.S.
Tracks disparities in quality of and access to health care in the U.S.
CMS Offers Cultural and Linguistic Competence Initiative
Cultural competence training is proven to enhance patient satisfaction and cross-cultural attitudes, knowledge and skills among health care providers.
Cultural competence training is proven to enhance patient satisfaction and cross-cultural attitudes, knowledge and skills among health care providers.
Patient Safety Resources for GHI Providers
Comparative data to help you compare your performance against regional and national benchmarks and design improvement programs.
Comparative data to help you compare your performance against regional and national benchmarks and design improvement programs.
Recommended Childhood and Adolescent Immunization Schedule, 2008
This schedule gives recommended ages for routine administration of currently licensed childhood vaccines for children through age 18 years.
This schedule gives recommended ages for routine administration of currently licensed childhood vaccines for children through age 18 years.
NYCDOH Newsletter Alerts
News bulletins from the New York City Department of Health have valuable information on current health topics for your patients.
News bulletins from the New York City Department of Health have valuable information on current health topics for your patients.
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New York State Nursing Home Profile
Use this site for information about nursing homes in New York State and the quality of care they provide.
Use this site for information about nursing homes in New York State and the quality of care they provide.
Medical Policy Subcommittee Technology Updates
