PROVIDER ID NUMBERS AND PLAN CODES

MAPDR-05 02/05/2019

Medicaid Managed Care Plan

Medicaid Managed Care Plan Provider BP eMedNY Telephone Boroughs

ID Code Number

Affinity Health Plan 00477156 02 82 800-553-8247

Emblem Health (Formerly Health Insurance Plan of Greater NY 00313979 07 99 800-447-8255

[GHI/HIP]

Fidelis Care 01751046 66 SP 888-343-3547

HealthFirst PHSP, Inc. 01479670 01 SF 866-463-6743 All

HealthPlus, an Amerigroup Company 01617894 66 KP 800-950-7679

Metro-Plus (Metropolitan Health Plus) 00894519 03 92 800-303-9626

United Healthcare Community Plan 01403176 01 MO 800-396-7177

Wellcare of New York, Inc 01182503 66 WC 800-288-5441 All, except SI

Health and Recovery Plan (HARP) Managed Care Plans

HARP Name MMC Plan Name HARP HARP Plan HARP Telephone TTY/TDD
Provider ID Code BP Number

Blended Wellness Plan Affinity Health Plan, Inc. 04342307 AF 78 866-247-5678 800-662-1220

HealthFirst Personal
Healthfirst PHSP, Inc. 04003696 HF 78 855-659-5971 800-874-9426
Wellness Plan

EmblemHealth Enhanced Health Insurance Plan of Greater

04082293 HI 78 855-283-2146 888-447-4833
Care Plus New York, Inc. (Emblem)

Empire Blue Cross HealthPlus, LLC (Empire BCBS

04004537 AA 78 800-600-4441 800-855-2880
BlueShield HealthPlus HealthPlus)

MetroPlus Enhanced MetroPlus Health Plan, Inc 04053201 MT 78 800-303-9626 800-881-2812

New York State Catholic Health

HealthierLife 04004486 NC 78 888-343-3547 800-662-1220
Plan, Inc. (Fidelis)

MAPDR-05 (02/05/2019) Page 1 of 5

 HIV Special Needs Plans (SNP)

Plan Name Provider ID eMedNY Telephone Number Boroughs

Code
HIV Special Needs Plans
(SNP) Amida Care Inc. 02191582 OD 800-556-0689 All

Metro Plus 02191362 OM 800-303-9626

All, except SI
VNSNY Choice Select 03420871 VS 866-265-7306

Medicaid Advantage/Dual Eligible Plans

Medicaid Advantage/Dual Eligible Plans eMedNY Customer Boroughs

(BP Code = 71) Provider ID TTY/TDD
Code Service

Fidelis Dual Advantage NYC 02738989 YD 800-247-1447 800-695-8544 All

UnitedHealthcare Dual Advantage 03238240 YU 800-514-4912 877-486-2048 All

Brooklyn, Bronx,
Wellcare Liberty (Medicaid Advantage Plan) 02645710 YW 800-650-4359 877-247-6272
Queens

VNS MA Advantage 03412686 VN 866-783-1444 711 All

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 MA Advantage Plus Plans

Plan Name Plan Address Boroughs Plan TTY/TDD Provider eMedNY BP

Tel. No. ID Code

6323 7th Avenue

Elderplan, Inc. All 866-386-9437 800-662-1220 03173113 YL 72
Brooklyn, NY

95-25 Queens Blvd.

Fidelis All 877-533-2404 800-558-1125 02927631 YF 72
Rego Park, NY 11374

Guildnet Gold, Inc. 15 West 65th Street, 4th Fl All, except

800-932-4703 800-662-1220 02942923 YG 72
New York, NY 10023 Staten Island

100 Church Street New

HealthFirst CompleteCare All 888-260-1010 888-542-3821 03420808 MH 72
York, NY 10007

HealthPlus, an Amerigroup 241 37th St, 4th Fl. All

866-805-4589 800-855-2880 03173080 YO 72
Company Brooklyn, NY 11232

Senior Whole Health of

15 MetroTech Center 11th Fl All, except
New York Medicaid 877-353-0185 711 02932896 YH 72
Brooklyn, NY 11201 Staten Island
Advantage Plus

VillageCareMAX Total 120 Broadway, Suite 2840 All. except

212-337-5750 711 04682248 VM 72
Advantage Plan New York, NY 10271 Staten Island

1250 Broadway, 11th Fl.

VNSNY CHOICE Total All 866-597-6674 711 02914056 YN 72
New York, NY 10001

Program For All Inclusive Care For The Elderly (PACE) Plans

Plan Name Plan Address Boroughs Plan Provider eMedNY BP

Tel. No. ID Code

33 Irving Place, 11th Fl. Bronx, Manhattan,

ArchCare Senior Life 866-263-9083 03114514 AC 75
New York, NY 10003 Staten Island

Centerlight Healthcare 612 Allerton Avenue

All 877-226-8500 01234037 C7 75
PACE Bronx, NY 10457

MAPDR-05 (02/05/2019) Page 3 of 5

 Managed Long Term Care (MLTC) Partial Cap Plans

Plan Name Plan Address Boroughs Plan Provider eMedNY BP

Tel. No. ID Code

55 West 125th Street, 13th Fl. Brooklyn,

Aetna Better Health 855-456-9126 03458546 AH 66
New York, NY 10027 Manhattan,Queens
271-11 76th Avenue All, except
Agewell 866-586-8044 03481927 AG 66
New Hyde Park, NY 11040 Staten Island
33 Irving Place, 11th Fl. New
Archcare Community Life All 855-467-9351 03466800 AP 66
York, NY 10003
Centers Plan For Healthy 75 Vanderbilt Avenue, Suite 600
All 855-270-1600 03506989 CP 66
Living Staten Island, NY 10304
5901 Palisades Avenue
ElderServe Health Inc. All 800-370-3600 03234044 EH 66
Riverdale, NY 10471
21 Penn Plaza, Suite 304
Extended All 855-299-6492 03549135 EC 66
New York, NY 10001
95-25 Queens Blvd.
Fidelis Care at Home All 800-688-7422 01788325 GD 66
Rego Park, NY 11374
15 West 65th Street, 4th Fl. All 800-932-4703 01827572 GN 66
Guildnet, Inc. New York, NY 10023
HealthPlus, an Amerigroup 241 37th St, 4th Fl.
All 800-600-4441 02644562 KX 66
Company Brooklyn, NY 11232
6323 Seventh Avenue
HomeFirst, Inc All 866-389-2656 03253707 ED 66
Brooklyn, NY 11220
257 Park Avenue South, 2nd Fl. All, except
Independence Care System 877-427-2525 01865329 IX 66
New York, NY 10010 Staten Island
2701 Emmons Avenue
Integra All 855-661-0002 03475427 IT 66
Brooklyn, NY 11235
160 Water Street, 3rd Fl. All, except
MetroPlus Staten Island 855-355-6582 03466906 MP 66
New York, NY 10038
200 Corporate Boulevard South Bronx
Montefiore Diamond Care 855-556-6683 03594052 MF 66
Yonkers, NY 10701
Senior Health Partners A 100 Church Street, 14th Fl.
All 866-585-9280 02104369 H1 66
Healthfirst Company New York, NY 10007
Senior Whole Health of 15 MetroTech Center 11th Fl All, except
877-353-0185 03459881 SW 66
New York MLTC Brooklyn, NY 11201 Staten Island
UnitedHealthcare Personal 77 Water Street, 14th Fl.
All 877-512-9354 03439663 UH 66
Assist New York, NY 10005
154 Christopher Street All, except
VillageCareMax Staten Island 800-469-6292 03420399 VL 66
New York, NY 10014
1250 Broadway All
VNSNY CHOICE 888-867-6555 01750467 VC 66
New York, NY 10001
1 New York Plaza, 15th Fl.
WellCare Advocate All 866-661-1232 02825230 WN 66
New York, NY 10004

MAPDR-05 (02/05/2019) Page 4 of 5

 Fully Integrated Dual Advantage (FIDA)

General Plan Name FIDA Plan Name Provider ID eMedNY Telephone Boroughs BP
(MMIS #) Code Number

AgeWell New York FIDA AgeWell New York, LLC 03864495 FC 866-586-8044 All, except
77
Staten Island
Centers Plan for Healthy Living
FIDA Care Complete 03870064 FH 1-800-466-2745 All 77
LLC

Elderplan, Inc Elderplan FIDA Total Care 03864784 FI 1-855-462-31467 All 77

Elderserve Health, Inc RiverSpring FIDA Plan 03864500 FJ 1-800-950-9000 All 77

GuildNet Gold Plus FIDA
Guildnet, Inc 03863105 FL 1-800-815-0000 All 77
Plan
Healthfirst AbsluteCare FIDA
Managed Heatlh (Healthfirst) 03878457 FM 1-855-675-7630 All 77
Plan

MetroPlus Health Plan MetroPlusFIDA Plan 03864793 FR 1-844-288-3432 All, except

77
Staten Island

Senior Whole Health of New All, except

SWH Whole Health FIDA 03897289 FY 1-844-861-3432 77
York, Inc. Staten Island

VillageCareMax Full All, except

VillageCareMax 03866988 FV 1-800-469-6292 77
Advantage FIDA Plan Staten Island
VNSNY Choice FIDA
VNS Choice 03885696 FW 1-866-783-1444 All 77
Complete

Fully Integrated Dual Advantage (FIDA) – Individuals with Developmental Disabilities (IDD)

Plan Name Plan Address Provider ID Telephone Number Boroughs Plan BP

Code
33 Irving Place, 11th Fl.
Partners Health Plan 04099212 1-646-844-4020 All PO 80
New York, NY 10003

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