Provider Resources
Claims submission Address:
ATRIO Health Plans
338 Jericho Turnpike #135
Syosset, NY 11791
Please continue to send REFUND CHECKS to:
ATRIO Health Plans
2965 Ryan Drive SE
Salem, OR 97301
Provider Updates
Annual Wellness Visit vs. Annual Physical Exam
Provider Education
- Provider Manual
- Issuing an Advanced Written Notice of Non-Coverage
- SNP Model of Care Training Manual
- Fraud, Waste and Abuse Compliance Training
- Clinical Practice Guidelines (CPG)
- CAHPS Information
- Quick Reference Guide
Pharmacy
- Medicare Advantage Formulary Information
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The PPO Formulary is a tiered formulary that consists of 6 tiers.
Tier 1 – Preferred Generic Drugs - lowest cost generic drugs
Tier 2 – Generic Drugs - may include few preferred brand
Tier 3 – Preferred Brand Drugs - may include high-cost generic drugs
Tier 4 – Non-Preferred Brand Drugs - non-preferred brand or generic, non-formulary drugs
Tier 5 – Specialty Drugs - highest cost-sharing tier
Tier 6 – Select Care Drugs (Zero-copay) -
Biosimilars
- Biosimilars 101: A Primer for Your Practice
- Test Your Skill: Incorporating Biosimilars Into the Management of Patients with Immunological Conditions
- Biosimilars in the Real World: Perspectives for Staying Within the Scope of Care
- Putting the Patient into Perspective: Strategies for Educating Patients About Biosimilars
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Inflation Reduction Act
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Insulins – Zero copay for initial coverage until the member reaches the coverage gap. When in the coverage gap, member copay will be capped at $35 for 30-day supply even if member has not met their annual deductible
- Part D vaccines - Zero copay
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US Inflation Reduction Act (IRA): 2023 Medicare Prescription Drug Changes Drug Cost Inflation Increase Limits Beneficiaries pay less for some drugs covered under Medicare Part B and nearly all Part D covered drugs, if the drug cost increases faster than the US inflation rate (Part B 20% coinsurance is based on the lower-adjusted price) Insulin Products Beneficiaries may not pay more than $35 for a 30-day supply of Part D insulin products even if they have not met their deductible(s) or have entered the Part D Coverage Gap. Effective July 1, 2023, insulin covered by Part B (applicable when administered using an insulin pump) also may not cost more than $35 for a 30-day supply
NOTE: Between January 1st and January 18th, 2023, ATRIO members may have been charged more than $35 for Part D insulin if they were in the Coverage Gap or if they received a non-formulary insulin product (e.g., Lantus) during a transition fill(s)
Vaccines Beneficiaries must not have cost-sharing for all vaccines recommended for adults by the Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP), such as the shingles vaccine; this change brings Part D vaccine coverage more in line with Part B for other approved vaccines (including the flu and COVID-19) NOTE: Following the end of the US Public Health Emergency (PHE) on May 11, 2023, cost-sharing may begin to apply for approved Part B COVID treatments |
Tools and Resources
- Provider Appeal Form - Electronic Submission
- Provider Appeal Form - Fillable PDF
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Provider Claim Dispute Form - Electronic Submission
- Provider Payment Dispute: Providers disputing the way a claim was paid.
- Par Provider Reconsideration: A contracted provider may file when a claim or claim line is denied. This is not a CMS requirement, but a service provided by ATRIO to contracted providers.
- Provider Claim Dispute Form - Downloadable PDF (Print and Fax)
- Medical Record Audit Response Form - Electronic Submission
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To submit claims directly to American Specialty Health please use below link:
https://www.ashlink.com/ASH/WCMGenerated/ClaimsSubmission031517_tcm17-126962.pdf
- Qualified Medicare Beneficiary (QMB) Program
- PCP Attestation Form
- Medicare Advantage Plans Benefit Information
- Medicare Advantage Provider Directory
- Notice of Medicare Non-Coverage (NOMNC)
- Notice of Medicare Non-Coverage (NOMNC) - Instructions
- Notice of Medicare Non-Coverage (NOMNC) - SNF Checklist
- Waiver of Liability Form
- Protected Health Information Disclosure Form
- Appointment of Representative Form (CMS - 1696) (For Medicare Appeals, Grievances, and Coverage Requests only)
- Provider Policy Listing
Medicare Star Rating Resources
View ATRIO’s Star Ratings Program page for measure descriptions and resource materials.
For questions on the Star Ratings Program, please click here to contact ATRIO Quality Improvement.
Opioid Information for Prescribers
Opioid drugs (“opioids”) have serious risks such as addiction, overdose, and death. CMS is very concerned about the opioid epidemic and its effect on our communities, and is committed to a complete strategy to combat this public health emergency. Several drug management programs are in place to prevent and combat opioid overuse.
Click here to see the formulary-level opioid safety edits at the point of sale, as recommended by CMS.
Medicare Part D Prescription Opioid Policies
Payer IDs
VSP Information:
VSP Provider Customer Service Line:
1.800.615.1883 Monday – Saturday: 6:00 a.m. – 5:00 p.m. PST
Sunday: Closed
Additional helpful provider information can be found at the following link:
https://www.vspproviderhub.com/
To learn more about becoming an in network VSP provider please see link below:
https://www.vspproviderhub.com/working-with-vsp/be-a-vsp-doctor.html
Extra Benefits:
To see extra benefits ATRIO offers, please select the link below: