Provider Documents


Thank You for being a Provider of Health Pointe Direct Complete Plan (HMO I-SNP)

Complete your Medicare Prescription Drug Coverage Determination or Appeal/Redetermination Request by either calling us, faxing or mailing the form, or online through the electronic form or Part D Provider Portal.

More information can be found on the Medicare Part D (Pharmacy) Information page or Provider Portal page.

Appointment of Representative

Evidence of Coverage

Complaint Form

HIPAA Privacy

HP Enrollment Form

Multi-Language Insert

Non-Discrimination

Summary of Benefits

(Draft – Pending 2020 Rates)

Provider Directory

Annual Notice of Change

Prior Authorization

Criteria

Step Therapy

Criteria

Pharmacy Directory

Low Income Subsidy Premium Summary Table

Appeal/Redetermination Request

Coverage Determination Request

Direct Member Reimbursement

Rx Claim Form

Personal Medication List

Contact Us:

Toll-Free: 1.844.269.3442 

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 1-844-269-3442 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 1.844.269.3442 / TTY: 711

Health Pointe of New York is an HMO I-SNP with a Medicare Contract. Enrollment in Health Pointe of New York depends on contract renewal.

CMS Material ID: H1722_HPweb2019 | Last updated 01/17/2020

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