doczyai-pipelines/streamlit_multipage/Demo_Test_data.csv

Filename,Agreement_Name (Contract Title),PAYER NAME,Health Plan State,Affiliate (Y/N),Credentialing Application Indicator,Term Clause,"Evergreen, Fixed or Hard Term",Termination Date,Termination Upon Notice - Days,Termination With Cause - Days,Amend Contract Upon notice Flag (Y/N),Timeframe  to Object - Days,Assignments Clause  (Y/N),Contract Effective Date,IRS #,IRS_Name,NPI (10-digits),NPI_NAME,PROV_GROUP_TIN_SIGNATORY,PROV_TIN_OTHER,PROV_NPI_OTHER,Notice to Provider Name,Notice to Provider Address,Sequestration Language,"Sequestration Reductions, included [Medicare only] (Y/N)",PROV_TIN_OTHER.1,PROV_NPI_OTHER.1,Parent Agreement Code,Pages,page_num,Attachment/Exhibit,Line of Business,Provider Type,Provider Type - Level 2,Service Type,Plan Type,"Lesser of Logic Language, included (Y/N)",Lesser of Rate,Reimb. Methodology,Reimb. Methodology_short,If rate is % of Payer or MCR [STANDARD],If rate is % of Payer or MCR [STANDARD]_Short,If rate is Flat Fee [STANDARD],Default Term,Default Rate,"Inclusion of essential RBRVS ""Fee Source"" Language (Y/N)","CDM Neutralization Language, included (Y/N)",Chargemaster Protection Language,Exclusions,Not to Exceed,Escalator or COLA (Y/N),"Escalator I, Eff. Date",IP/OP,"IP - DSH/IME/UC, included (Y/N)",IP - Stoploss Catastrophic Threshold
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Inpatient Covered Services - Medical/Surgical,,N,,"103.5 percent of the applicable CMS Medicare Inpatient Prospective Payment (IPPS) rates of Medicare Severity Diagnosis Related Groups (MS-DRGs) published on the CMS website on the date of the Member's discharge, including associated add-on and outlier payments as determined by CMS. All costs that are excluded by CMS from the IPPS rate will not be paid by Health Plan.",103.% of MCR,103.5% of MCR,1.035,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,All costs that are excluded by CMS from the IPPS rate will not be paid by Health Plan.,,N,,IP,N,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Inpatient Covered Services - Inpatient Rehabilitation,,N,,103.5 percent of Health Plan's Medicare rate schedule based on the applicable CMS Medicare Case-Mix Group (CMG) rates for inpatient rehabilitation published on the CMS website on the date of the Member's discharge.,103.% of MCR,103.5% of MCR,1.035,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,IP,N,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Inpatient Covered Services - Inpatient psychiatric /Alcohol/Substance Abuse Covered Services rendered to Member in an inpatient psychiatric facility or unit within the Provider's hospital facility,,N,,"$1,750 per diem",Flat Fee,,,"$1,750 Per Diem","All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,Y,1-Apr-22,IP,N,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Specialty Hospital - IP Specialty Hospital for Long Term Acute Care: - IP Specialty Hospital for Long Term Acute Care Covered Services rendered to Member within Henry J. Carter Specialty Hospital,,N,,"$2,250 per diem (Non-COVID 19 Diagnosis) $2,750 per diem (COVID19 Diagnosis: ICD. 10 Code - U07.1) $350 per treatment (Dialysis Add-On: Rev Codes 0800-0809)",Flat Fee,,,"$2,250 Per Diem (Non-COVID 19 Diagnosis) / $2,750 Per Diem (COVID19 Diagnosis) / $350 Per Treatment (Dialysis Add-On)","All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,Y,1-Apr-22,IP,N,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,"Outpatient Covered Services - Emergency Room (technical only, not inclusive of physician services)",,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - Urgent Care (Per Visit) (Rev Code 0516),,N,,150 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR OPPS/APC rates,150% of MCR OPPS/APC rates,1.5,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,"Outpatient Covered Services - Ambulatory Surgery (Including but not limited to Lithotripsy, PTCA, Cardiac Cath, Laparoscopy)",,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - Observation,,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - PT/OT/ST (Per Visit),,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - Dialysis,,N,,110 percent of the End Stage Renal Dialysis (ESRD) Prospective Payment System (PPS) rates published on the CMS website on the date the Covered Service is rendered.,% of ESRD PPS rates,110% of ESRD PPS rates,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - Chemotherapy Administration (Excludes Drugs),,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,Excludes Drugs,,N,,OP,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - Behavioral Health: -Intensive Outpatient Mental Health / Substance Abuse -Partial Hospitalization -Continuing Day Treatment -ECT -Ambulatory Detox -Telehealth Services,,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - Lab/Radiology/Pathology,,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - Radiation Therapy Hyperbaric Therapy,,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - MRI / CAT Scan / PET Scan / Sonograms,,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered.,% of MCR OPPS/APC rates,110% of MCR OPPS/APC rates,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - Trauma Activation Fees (Rev Codes 0681-0684),,N,,60% of Charges,% of BC,60% of BC,0.6,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Outpatient Covered Services - All Other Outpatient Services (including clinic and DTC services),,N,,110 percent of the applicable CMS Medicare Outpatient Prospective Payment System (OPPS)/APC rates published on the CMS website on the date the Covered Service is rendered or other successor CMS methodology as applicable.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,FQHC,FQHC Services (Payment Codes G0466-G0470),,N,,110 percent of the applicable CMS Medicare FQHC Prospective Payment System rates published on the CMS website on the date the Covered Service is rendered or other successor CMS methodology as applicable.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,All other outpatient services not priced by Medicare,,N,,"115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",% of MCD,115% of MCD,1.15,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,OP,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Primary Care Services: (CPT-4 Codes 99201-99499),,N,,110 percent of the CMS Medicare physician fee schedule for the applicable locality published on the CMS website on the date the Covered Services are rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,OBGYN Maternity Care and Deliveries: (CPT-4 Codes 59000-59622),,N,,110 percent of the CMS Medicare physician fee schedule for the applicable locality published on the CMS website on the date the Covered Services are rendered.,% of MCR,110% of MCR,1.1,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Specialty Services,,N,,103.5 percent of the CMS Medicare physician fee schedule for the applicable locality published on the CMS website on the date the Covered Services are rendered.,103.% of MCR,103.5% of MCR,1.035,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Anesthesia Conversion Factor (15 Minute Time Units) (CPT-4 Codes 00100 to 01999),,N,,$45 per unit,Flat Fee,,,$45 per unit,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,Y,1-Apr-22,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Telehealth Services,,N,,103.5 percent of the CMS Medicare physician fee schedule for the applicable locality published on the CMS website on the date the Covered Services are rendered.,103.% of MCR,103.5% of MCR,1.035,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,Allied Health Professionals,,N,,85 percent of the CMS Medicare Primary Care Services fee schedule referenced above for the applicable locality published on the CMS website on the date the Covered Services are rendered.,% of MCR,85% of MCR,0.85,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,All other Specialties,,N,,103.5 percent of the CMS Medicare physician fee schedule for the applicable locality published on the CMS website on the date the Covered Services are rendered.,103.% of MCR,103.5% of MCR,1.035,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,37,ATTACHMENT C-1 MEDICARE ADVANTAGE PROGRAM COMPENSATION (HOSPITAL AND PROFESSIONAL),MEDICARE ADVANTAGE,Facility,Hospital,All other professional services not priced by Medicare,,N,,"115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",% of MCD,115% of MCD,1.15,,"All other outpatient services not priced by Medicare | 115 percent of the applicable NYS Medicaid rate. If no price, 60% of Charges.",60% of Charges,N,N,,,,N,,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,Skilled Nursing Facility,Health Plan's Medicare SNF Per Diem Rate Table - Level 1,,N,,Level 1 | $575 | 191,Flat Fee,,,$575 ,,,N,N,,,,Y,1-Apr-22,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,Skilled Nursing Facility,Health Plan's Medicare SNF Per Diem Rate Table - Level 2,,N,,Level 2 | $675 | 192,Flat Fee,,,$675 ,,,N,N,,,,Y,1-Apr-22,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,Skilled Nursing Facility,Health Plan's Medicare SNF Per Diem Rate Table - Level 3,,N,,Level 3 | $725 | 193,Flat Fee,,,$725 ,,,N,N,,,,Y,1-Apr-22,IP,N,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,Skilled Nursing Facility,Health Plan's Medicare Specialty SNF Per Diem Rate Table - Traumatic Brain Injury (Seaview Only),,N,,Traumatic Brain Injury (Seaview Only) | $875 | 199,Flat Fee,,,$875 ,,,N,N,,,,Y,1-Apr-22,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,Skilled Nursing Facility,Health Plan's Medicare Specialty SNF Per Diem Rate Table - Ventilator (Harry J. Carter Only),,N,,"Ventilator (Harry J. Carter Only) | $1,325 | 199",Flat Fee,,,"$1,325 ",,,N,N,,,,Y,1-Apr-22,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,Skilled Nursing Facility,Covered Services,,N,,"Effective April 1, 2022, services priced at a flat rate shall be increased by 3% annually up to year 3 through March 31, 2024.",% of AC,3% of AC,0.03,,,,N,N,,,,Y,1-Apr-22,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,,Home Health Care - Skilled Nursing,,N,,Skilled Nursing | 551 | $180 per visit,Flat Fee,,,$180 per visit,,,N,N,,,,Y,1-Apr-22,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,,Home Health Care - LPN,,N,,LPN | 550 | $180 per visit,Flat Fee,,,$180 per visit,,,N,N,,,,Y,1-Apr-22,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,,Home Health Care - Medical Social Services,,N,,Medical Social Services | 561 | $230 per visit,Flat Fee,,,$230 per visit,,,N,N,,,,Y,1-Apr-22,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,,Home Health Care - Physical Therapy,,N,,Physical Therapy | 421 | $195 per visit,Flat Fee,,,$195 per visit,,,N,N,,,,Y,1-Apr-22,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,,Home Health Care - Speech Therapy,,N,,Speech Therapy | 441 | $215 per visit,Flat Fee,,,$215 per visit,,,N,N,,,,Y,1-Apr-22,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,,Home Health Care - Occupational Therapy,,N,,Occupational Therapy | 431 | $200 per visit,Flat Fee,,,$200 per visit,,,N,N,,,,Y,1-Apr-22,,,
13-2655001-New York City Health and Hospitals Corporation-ICMProviderAgreement_318243_1,PARTICIPATING PROVIDER AGREEMENT,"WellCare of New York, Inc., WellCare Health Insurance of New York, Inc. and American Progressive Life and Health Insurance Company of New York",New York,Yes,Yes,"7.1 Term. The term of this Agreement shall begin on the Effective Date and continue for a period of one year, and thereafter shall renew for successive periods of one year each unless a Party provides notice of nonrenewal to the other at least 90 days before the end of the then current (initial or renewal)term, unless and until the Agreement is terminated in accordance with the terms and conditions of the Agreement, including those in a Program Attachment.",Evergreen,,90,90,Yes,,Yes,4/1/2021,13-2655001,New York City Health and Hospitals Corporation,,,,,,,"160 Water Street 6th Flr Rm 642 New York, NY 10038",,,,,318243,43,41,ATTACHMENT C-2 MEDICARE ADVANTAGE COMPENSATION (SKILLED NURSING FACILITY & HOME HEALTH SERVICES) (FEE FOR SERVICE),MEDICARE ADVANTAGE,Facility,,Home Health Care - Home Health Aide,,N,,Home Health Aide | 571 | $85 per visit,Flat Fee,,,$85 per visit,,,N,N,,,,Y,1-Apr-22,,,
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