MedicaidSeptember 30, 2020
SOMOS to manage delegated functions effective October 1, 2020
Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.
Effective October 1, 2020, for MMC, HARP, CHPlus and Essential Plan members in New York assigned to a SOMOS PCP, SOMOS will assume administrative functions including but not limited to: credentialing, population health management/transitional care management, utilization management and claims processing.
Prior authorization requests
Providers should contact SOMOS for prior authorizations at 1-844-990-0255.
Medical management
To obtain authorization or to verify member eligibility, benefits and account information, please call the telephone numbers listed on the back of the member’s ID card.
There are few different ID card layouts. Below is an example of one the ID cards. Other member’s ID cards may vary slightly from example below.
Claims processing
SOMOS encourages all claims to be submitted electronically using the below payer ID #s |
|
SOMOS |
81508 |
Paper claims submitted should be submitted to the following: |
|
Attn: SOMOS IPA, LLC |
|
Please note:
|
Credentialing process
IPA providers: SOMOS will handle all credentialing for its participating providers. This includes submission of any demographic changes or terminations.
Non-IPA providers: Providers who are not contracted with the IPA must continue to follow the Empire processes.
If you have any questions, please contact Empire’s Provider Services department at 1-844-990-0255.
PUBLICATIONS: October 2020 Empire Provider News
To view this article online:
Or scan this QR code with your phone