Dear colleagues,

Happy National Doctors' Day this Sunday, March 30! We at Mount Sinai are grateful and proud of all you do to provide excellent care for patients and families in the community. We also greatly value your choice to be a member of our Clinically Integrated Network.

Warm Regards,

Arshad K. Rahim, MD, MBA, FACP

Senior Vice President and Chief Medical Officer, Population Health

Mount Sinai Health System

Chief Medical Officer

Mount Sinai Health Partners

As some of you are unfortunately aware, Anthem has been randomly and incorrectly changing the participation status of some of our providers. As a result, patients are receiving letters from Anthem stating their provider is no longer in network. Additionally, we are unable to obtain in-network prior authorizations from Anthem.

To avoid disruption in care and service cancelations, affected providers may continue to provide services, and any claims processed as out of network or denied for no authorization will be reprocessed as in-network, with no penalties for lack of a prior authorization.

Unfortunately, since this issue is being caused by Anthem, we have no way of knowing which providers may be impacted or when. Please escalate issues related to this problem to us at mshp@mountsinai.org or 877-234-6667.

For more information, please refer to this communication sent on March 14.

To ensure that we can continue to provide value and high-quality service to our network, we collect annual member dues. You should have received an email invoice with your 2025 member dues on Monday, March 10, and a print invoice via postal mail later in the week.

All CIN providers must pay annual dues in order to remain in good standing with the CIN. Please remit payment online (login required) by May 9, 2025.

Voluntary PCPs and pediatricians in our network will receive customized value-based care (VBC) performance reports in their OneDrive accounts in early April. The patient opportunity report includes patient-level information on care gaps and can be used to identify cohorts of patients that need visits to re-engage in care, close quality care gaps, and/or manage and document chronic conditions. Please be sure to use these reports for effective patient outreach.

2025 reimbursement rates for the top 10 E/M codes are now available on the MSHP provider portal for most contracted health plans. We will continue to update this page as we receive rates from the outstanding health plans.

Cigna Commercial

We are pleased to announce that Mount Sinai has reached an agreement with Cigna to continue participating in their commercial plans. Patients who obtain Cigna health insurance through their employer will have uninterrupted in-network access to Mount Sinai physicians, hospitals, and outpatient services. 

Humana Medicare Advantage

As of Saturday, March 1, Mount Sinai Health System is no longer in Humana’s Medicare Advantage network. All Mount Sinai providers, hospitals, and related hospital outpatient locations are out of network for patients with these plans. Non-employed providers in Mount Sinai’s Clinically Integrated Network are also out of network with Humana Medicare Advantage plans.

Now Available: 2025 Quick Guides

Review the CIN Contracts Quick Guide to see, at a glance, which health plans you are contracted with through the CIN.

Please use the 2025 Preferred Laboratories Guide and ensure you choose payer preferred laboratories when requesting lab services.

Thank you to all who joined us on February 19 at the MSHP Town Hall Gathering!

Mount Sinai’s Chief Clinical Officer, Dr. David L. Reich, and Chief Executive Officer of the Mount Sinai Doctors Faculty Practice, Dr. Kelly Cassano, spoke at the beginning of the meeting. We also covered requirements and performance metrics for the 2025 CI Program, as well as policy and payer updates.

If you were unable to attend, or would like to review the information presented, please visit our Media Library (log-in required) to access the Town Hall slide presentation and recording. 

The MSHP Chronic Condition Management Hub is a resource center for providers caring for patients with behavioral health needs, chronic kidney disease, COPD, diabetes, heart failure, hyperlipidemia, hypertension, and/or peripheral artery disease.

We recently redesigned this hub to improve your user experience. You'll find ambulatory care pathways, quick reference guides, patient materials, and more.

Aetna Medicare Member Resources

Please review Aetna's 2025 Medicare Member Resources.

UMR Address Change

Effective immediately, UMR’s claims submission address has changed. Their new address is:

UMR

P.O. Box 211762

Eagan, MN 55121

Please note that there is a timely filing deadline of 12 months from the date of service for UMR. The EDI# 39026 will remain the same. Please see here for an updated 2025 Top Tier Guide to reflect this change. 

For more information, please refer to this communication sent on March 6.

Cigna Commercial Reimbursement Policy

Please review Cigna's 2025 commercial reimbursement policy.

Please also not that effective June 1, 2025, except in the case of preventive E/M services, Cigna will not separately reimburse CPT code 99459 when reported with E/M CPT codes 99202 – 99205 and 99212 -99215 as it is considered included in the E/M service.

You can view all recent Cigna Commercial updates on their Provider Newsroom site.

Specialty Care

Anthony Cultrara, MD

Otolaryngology

ENT and Allergy Associates

Mount Laurel Township, NJ

Ashmit Gupta, MD

Otolaryngology

ENT and Allergy Associates

Voorhees Township, NJ

Charles Marinello, PT

Physical Therapy

Zion Wellness PT PC

Brooklyn, New York

Daniel Vapne, PT

Physical Therapy

Zion Wellness PT PC

Woodmere, NY

Dara Cohn, MD

Allergy & Immunology

ENT and Allergy Associates

Mount Laurel Township, NJ

David Temmermand, MD

Otolaryngology

ENT and Allergy Associates

Woodbury, NJ

Gabriel Levi, MD

Pathology - Anatomic/Pathology - Clinical

Gil I. Ascunce MD, PC

New York, NY

Hannah Harrison, MD

Allergy & Immunology

ENT and Allergy Associates

Medford, NJ

Howard Bresalier, DO

Otolaryngology

ENT and Allergy Associates

Washington Township, NJ

Jeanne Seepaul, PT

Physical Therapy

Zion Wellness PT PC

Brooklyn, New York

Jeffrey Ainspan, MD

Dermatology

Forest Hills Dermatology Group PLLC

New York, NY

John Kim, MD

Allergy & Immunology

ENT and Allergy Associates

Medford, NJ

Kartik Dandu, MD

Otolaryngology

ENT and Allergy Associates

Mount Laurel Township, NJ

Kelly Speich, MD

Otolaryngology

ENT and Allergy Associates

Mount Laurel Township, NJ

Kevin Wu, MD

Ophthalmology

Union Square Eye Center, LLC

New York, NY

Maaz Jalil, DO

Allergy & Immunology

ENT and Allergy Associates

Medford, NJ

Mark Friedel, MD

Otolaryngology

ENT and Allergy Associates

Voorhees Township, NJ

Michael Mecner, PT

Physical Therapy

Zion Wellness PT PC

Brooklyn, New York

Milana Sapozhnikov, MD

Ophthalmology

A & D Medical PC

Brooklyn, NY

Min Ku, MD

Allergy & Immunology

ENT and Allergy Associates

Haddonfield, NJ

Nathan Kind, PT

Physical Therapy

Zion Wellness PT PC

Brooklyn, New York

Philip Rowan, MD

Otolaryngology

ENT and Allergy Associates

Medford, NJ

Rasesh Shah, MD

Otolaryngology

ENT and Allergy Associates

Woodbury, NJ

Samir Shah, MD

Otolaryngology

ENT and Allergy Associates

Voorhees Township, NJ

Shashank Sheth, MD

Allergy & Immunology

ENT and Allergy Associates

Voorhees Township, NJ

Tian Song, PT

Physical Therapy

Zion Wellness PT PC

Brooklyn, New York

Advanced Practice Providers

Ashley Doerler, PA

Bethany Medical Clinic of New York, PLLC

New York, NY

Lindsey Martin, PA

ENT and Allergy Associates

Voorhees Township, NJ

Melanie Ransom, NP

ENT and Allergy Associates

Medford, NJ

Primary Care

Sharon Kheradnam, MD

Internal Medicine

Corona Medical PC

Brooklyn, NY

We are excited to announce that our own Ava Johnson, Associate Director, Ambulatory CDQI Department, has been appointed to the American Academy of Professional Coders (AAPC)'s National Advisory Board. She joins a distinguished group of industry leaders dedicated to providing critical insights into healthcare trends, member needs, and strategic initiatives to advance AAPC’s mission and support the business of healthcare.

Congratulations Ava!

If you have any questions about any of our announcements, please contact your Population Health Manager, email Mount Sinai Health Partners at mshp@mountsinai.org or call us at 877-234-6667.  

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