Care Coordination Payments

Be on the lookout for your Q4 2022 care coordination payments in early April. We will notify you when they’re on their way!

Now Available: 2023 Voluntary Payer Plan Product Grid and Fee Schedules

Refer to this grid to see which products MSHP participates with for each health plan. See the story below for details on how you can view what payers you participate with and the date that you are active with each payer.

Reimbursement rates for top E&M codes for Manhattan localities are now available on our website (login required).

Please note that providers are required to check eligibility/verify coverage before care is provided.

View Your Health Plan Participation Summary

Did you know that you can view what payers you are participating with and the date that you are active with each payer?

Sign in to the MSHP Provider Portal and click on the “Payer Contracts” tile and then the “Health Plan Participation Summary” link to view your customized report. 

Keep in mind that MSHP’s provider data is sent to each payer on a schedule and that your participation date with a payer is dependent on the payer’s data processing. It can take at least 60-90 days for a payer to update their provider roster after MSHP’s submission. 

If you are a Practice Administrator who would like to request access to the Health Plan Participation Summary report, please contact your provider engagement representative, email us, or call 1-877-234-6667.

The End of the COVID-19 PHE: What You Need to Know

Telehealth changes effective 5/12/23 — All Payers

• Telehealth platforms must be HIPAA compliant

Medicare Fee-For-Service telehealth changes effective 5/12/23:

• Prescribers will be required to see a patient face-to-face before prescribing controlled substances
• If performing telehealth at home, practitioner will be required to report their home address on the Medicare enrollment site

Medicare Fee-For-Service telehealth flexibilities extended through 12/31/24:

• Medicare patients will continue to be able to receive telehealth in their homes and regardless of geographic location
• Medicare patients can continue to receive audio-only telehealth visits (eligible audio-only CPT/HCPCS codes)
• The expanded list of practitioners continues and includes physical and occupational therapists, speech language pathologists, and audiologists

Medicare Fee-For-Service Telehealth payment rates change as of 1/1/24:

Currently providers receive payment as if services had been provided in-person (at the non-facility based payment rate in offices); this will end on 12/31/23.

Beginning 1/1/24, practitioner services will be paid at the facility rates for telehealth office-based services (approximately 25-30% less than the in-person office-based rates).

To learn more refer to this CMS fact sheet

March Town Hall Gathering Recap and Materials

Thanks to all who took the time to attend our March Town Hall Gathering where we discussed:

• Mount Sinai Health System updates 
• Payer updates
• MSHP April reporting updates
• 2023 CDQI training

If you were unable to attend or would like to review any of the material presented, visit our Media Library (log-in required) to view the slides and recording.

Thank You for Your Feedback!

Thank you to all who took the time to complete the annual Provider and Office Manager Experience Survey. We sincerely value your feedback and are analyzing the results and strategizing on how to address your concerns and implement some new initiatives based on the feedback you provided. We look forward to an exciting year of ongoing growth and development!

Use Your Patient Panel Report for Effective Outreach

At the end of January you received your January 2023 Full Patient Panel Report in your practice's main OneDrive account. You will receive your next series of reports in early April.

Highlighted in the report are patients in your panel who have care gaps, including no PCP visit in the past 12 months, quality care gaps, and CDQI opportunities. Targeting your patient outreach according to this report can help you prioritize high-impact patients.

Join Us at an Upcoming Mind Matters ECHO Meeting

Mind Matters ECHO is a behavioral health learning collaborative for all providers who see patients with behavioral health needs

CBT for Insomnia

April 12, 2023

Topics TBD

May 10, 2023

June 14, 2023

Mark your calendar!

Mind Matters ECHO meets the 2nd Wednesday of each month except December. All providers are encouraged to attend and participate.

MSHP Board of Managers Spotlight: Dr. H. Jay Wisnicki

Meet our Mount Sinai Health Partners’ Board Member, H. Jay Wisnicki, MD. Dr. Wisnicki is an Ophthalmologist at Union Square Eye Care. We recently caught up with Dr. Wisnicki to learn more about him as a new MSHP Board member! 

I hope to help get patients the care they need and ease physician burdens. We have a large eye care center with two facilities in Manhattan seeing almost 40,000 patient visits per year. I would like to help others develop and improve their practices and work together in innovative ways. 

What are your interests/hobbies outside of work?

Piano, snowboarding, travel, playing with my 9 year old boy/girl twins (and wife of course)! 

We welcome and look forward to Dr. Wisnicki

serving on MSHP’s Board of Managers! 

Interested in becoming part of MSHP's governance? Join a committee today! Reach out to Lauren Hertan to learn more about how you can participate. 

Screening and Diagnostic Testing for CKD Management

Perform an ACR at least annually



• Order regular eGFR and albuminuria testing via a urine albumin to creatinine ratio (uACR) at least annually to determine disease progression
• Note: an annual eGFR and uACR is needed for the quality measure, Diabetic Kidney Health Evaluation
• eGFR is calculated via a blood test, basic or comprehensive metabolic panel (BMP or CMP)
• eGFR should be calculated based on serum creatinine, age, gender (typically on lab report; do not adjust by race)

Refer to the Mount Sinai CKD quick reference guide, designed specifically for primary care physicians and includes clinical guidelines developed with key nephrology leadership.

ICD-10 Coding for Chronic Kidney Disease

Ensure that your patients' true levels of complexity are accurately reflected by using accurate and specific documentation and coding.

This is not only essential to performance in value-based care reimbursement but also helps ensure that future quality of care and appropriate support services are made available.

Code for all stages of CKD to the maximum level of specificity possible at least once each calendar year, accounting for any progression of disease:

For patients with coexisting diabetes, ensure that Diabetes with Complications is documented using appropriate diagnosis codes:

For any questions about coding and documentation, please email Donna Malone, Director of Clinical Documentation and Quality Improvement.

EmblemHealth Update

Effective April 1, 2023, the Montefiore Care Management Organization (CMO) will no longer be the managing entity for the following members:

• EmblemHealth Enhanced Care (Medicaid)
• Enhanced Care Plus (HARP)
• Child Health Plus (CHPlus)
• HMO Prime
• HMO Access I
• HMO Plus
• HMO Preferred members.

CMO will no longer perform utilization management (including pharmacy), case management, claims payment, and behavioral health management services for these members.

Members currently managed by CMO will receive a new member ID card. Please refer to the back of the card or the Directory chapter of the provider manual for information on claims submission and authorization requests (including pharmacy) for dates of service on or after April 1, 2023.

If you see any patients after April 1 with CMO on their ID card you should verify eligibility as that card is outdated.

Cigna Updates

Paper Check Reimbursements for Silicon Valley Bank and Signature Bank Customers

If you typically received payments from Cigna via EFT to Silicon Valley Bank or Signature Bank, you will now receive paper checks instead to ensure that you continue to receive prompt payments of claims without disruption.

If you would like to re-enroll in EFT with a new bank, log on to the provider portal, click “Working with Cigna,” and then “Electronic Funds Transfer.” From that page, you can re-enroll in EFT payments and pick a bank of your choosing.

Medical Coverage Policy Update

Effective April 16 Cigna will deny claims related to affected ambulatory external and implantable electrocardiographic monitoring codes if billed alone or with codes that are not covered. Learn more.

New: Post-Visit Survey for Medicare Advantage Patients

Medicare Advantage patients will now receive a post-visit survey via mail or email after an office visit.

Press Ganey will generate results that show a comparison of your performance to others in the industry based on results of other payers in their book of business (for which they also administer the same post-visit survey). Your Cigna Medicare Advantage Network Operations Representative will share the results with you. Learn more.

UnitedHealthcare Policy Updates and Reminders

• UnitedHealthcare has shared several policy updates, including reimbursement for Preventive Medicine Services (such as counseling, anticipatory guidance, risk factor reduction interventions, and cancer screenings) in certain cases

• As a reminder, all claim reconsiderations and appeals must now be submitted electronically

Use modifier 25 when providing E/M services during a preventive care visit

If, during a preventive a care visit (99381-99387, 99391-99397), you additionally provide Evaluation and Management (E/M) services UnitedHealthcare will reimburse the Preventive Medicine Service plus 50% of the problem-oriented E/M service code when that code is appended with modifier 25. If the problem-oriented service is minor, or if the code is not submitted with modifier 25 appended, it will not be reimbursed.

Review UHC's full preventive policy

View Your Payments on the Provider Portal

On February 8, we announced the launch of My Payments, a new web-based tool that allows you to view and download an accounting of value-based payments your practice has received from MSHP based on eligibility, such as care coordination payments and performance-based annual incentive payments. 

To learn more, review this communication or download these user guides for detailed instructions on how to use the tool.



• For Providers: My Payments Provider User Guide
• For Office Managers: My Payments Office Manager User Guide

Welcome New MSHP Members!

We'd like to extend a warm welcome to all new provider members who recently joined our clinically integrated network.