Affinity Health Plan

    • QHP Provider Fact Sheet

      2015 Qualified Health Plans

      Fact Sheet for Providers: Find out about our new plans on and off the New York State of Health Marketplace.

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    • New 2015 Medicare Passport Plans

      New in 2015: Affinity Medicare Passport Plans

      Affinity has designed a new Medicare Advantage Prescription Drug Plan Portfolio that includes both HMO and HMO-SNP plans.

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    • Synergy Summer 2014 Edition

      The latest edition of Synergy is out!

      Find updates on Affinity policies, initiatives, clinical standards and industry news in the latest issue of our provider newsletter.

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    • prior authorization for prescriptions

      Pharmacy Update

      There have been some changes to the medication coverage for Medicaid, Child Health Plus and Family Health Plus plans.

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    • Authorization changes

      Authorization Changes

      Affinity Health Plan is changing its authorization guidelines for Occupational Therapy, Physical Therapy, Speech Therapy, Durable Medical Equipment (DME) and ambulatory surgery to help streamline our processes.

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  • Join our community of health providers

    Affinity partners with its provider network to improve the health of underserved populations. As our Mission states, “[Together], we strive to improve care-seeking and care-giving.” Providers interested in joining our network will find useful information about Affinity. You can get helpful details about submitting claims, learn about special programs we offer, and receive answers to frequently asked questions. Contracted Affinity providers can use our Web portal to check Member eligibility and claim status, look up Affinity providers for referrals and more.

    Click here for more information on joining our network.

    Has your contact information changed? Let us know!
    If you are a current provider, you can update your address, phone or fax number, or other contact information by completing and returning our Provider Information Update Form.

    Keeping you informed
    Affinity is committed to nurturing a fruitful relationship with its network providers. Our provider relations, contracting & credentialing unit engages with participants in our provider network to keep you informed about our policies, procedures, requirements and expectations. Field representatives make regular site visits to address administrative concerns of physicians and medical office staff. We always strive to streamline and simplify your transactions with us. 

    Affinity Health Plan’s Compliance Training
    The Centers for Medicare and Medicaid Services (CMS) guidelines require that we provide annual training on select topics related to public health programs.

    • Fraud, Waste, and Abuse (FWA): The FWA module encompasses key requirements related to the detection, prevention, correction, and reporting of fraud, waste, and abuse. All personnel/entities that qualify as a First-Tier, Downstream, or a Related Entity (“FDR”) must receive this annual training.
    • Special Needs Plan Model of Care (SNP MOC): The SNP MOC module covers metrics designed to improve Members’ access to medical, social, and mental health services and transitions of care across health care settings. All personnel/entities that are part of Affinity’s provider network must receive this annual training.

    For the SNP MOC and FWA training modules, click here.

    Contacts
    For general concerns, please contact our customer service staff at 1.866.247.5678. For specific issues, you may reach us at one of these numbers:

    Provider Relations: Nicole De La Vega, Sr. Manager: 718.794.5914

    Contracting: Stacey Adams, Manager: 718.794.5933

    Here are other Affinity departments who serve our provider network.