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Direct Complete Plan

H5989 Provider Documents


Annual Notice of Change

(ANOC)

Summary of Benefits

(SB)

Evidence of Coverage

(EOC)

Low Income Subsidy (LIS) Premium Table

Multi-Language Interpreter Services

Medicare Plan Ratings

Appeal/Redetermination Request Form

Coverage Determination Request

Prior Authorization Criteria

Step Therapy Criteria

Direct Member Reimbursement RX Claim Form

Personal Medication List

H5989 Provider Portals


Thank You for being a Provider of Health Pointe Direct Complete Plan

(HMO I-SNP)

Coverage Decisions

If a drug is not covered in the way you would like it to be covered, you can ask us to make an exception or coverage decision to our coverage rules. Similar to other types of coverage decisions, if we turn down your request for an exception, you can appeal our decision. When you ask for an exception, please explain the medical reasons why you need the exception approved for consideration. More information can be found on the Medicare Part D (Pharmacy) Information page or the Evidence of Coverage (PDF).

You can use one of the following methods to request a formulary exception:

  • Call 1-888-201-4342 (TTY users should call 711)
  • Submit Fax Request to 855-668-8550
  • Send Mail Requests to PO BOX 1039, Appleton, WI 54912-1039
  • Request for Medicare Prescription Drug Coverage Determination Form View  (PDF)


Submit Electronically

Making an Appeal/Redeterminations

If we make a coverage decision and you are not satisfied with this decision, you can appeal the decision or ask for a redetermination. You must make your appeal request within 60 calendar days from the date on the coverage decision written notice we sent. More information can be found on the Medicare Part D (Pharmacy) Information page or the Evidence of Coverage (PDF).


You can use one of the following methods to request an appeal:


Submit Electronically


Contact Us:

Toll-Free: 1.888.201.4342 

TTY: 711

Mailing Address:

Health Pointe of New York

810 Seventh Avenue - Suite 801

New York, New York 10019

Please contact our Member Services number at 1-888-201-4342 for additional information. (TTY users should call 711.) From October 1 to March 31, we are open 7 days a week, from 8 a.m. to 8 p.m. EST. From April 1 to September 30, we are open Monday through Friday, from 8 a.m. to 8 p.m. EST.

We do not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, sex, gender identity, age or disability in our health programs and activities.

ATENCION: Si habla español, tiene a su diposicion servicios gratuitos de assistencia linguistica. Llame a 1.888.201.4342 / TTY: 711

Health Pointe Direct Complete Plan (HMO I-SNP) is a Health Plan with a Medicare Contract. Enrollment in Health Pointe HMO I-SNP depends on contract renewal.

CMS Material ID: H5989_HPweb2019 | Last updated 12/10/2019

Health Pointe of New York COVID-19 Statement – H1711

Health Pointe of New York is closely monitoring the COVID-19 (Coronavirus) outbreak.

Click on the following links for the most up-to-date information from NYC.gov and The New York State Department of Health websites.

If you have any questions, please call Member Services at 844-269-3442.

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