Q. What is ArchCare?
A. ArchCare is the Continuing Care Community of the Archdiocese of New York. Our system is made up of nursing home alternatives that enable seniors and others with chronic health needs to continue to live safely and independently. Additionally, our community is composed of Skilled Nursing Homes and Assisted Living Programs, Home Health services for infants, children and adults; as well as Health Plans that coordinate all of a member's healthcare needs and the Medicare and Medicaid benefits for which they are eligible.
Q. What are the Health Plans offered by ArchCare?
A. ArchCare Advantage is a Medicare Institutional Special Needs Plan with members living both at home, in the community and in nursing homes. As long as you require nursing home level of care, our plan can help you with your very special needs, regardless of where you reside. This Plan provides managed long term services that traditional Medicare does not cover.
ArchCare Senior Life (PACE) is a Program of All-inclusive Care for the Elderly. PACE is a community-based healthcare program created for people 55 and over who require nursing-home-level care, but prefer to receive it in their own familiar surroundings. This is the only Plan that is offered by ArchCare in which the participant does not have to be dual-eligible (Medicare and/or Medicaid); will accept self-pay.
ArchCare Community Life is a Managed Long Term Care (MLTC) Program for dual eligible age 21 years or older and in need of community based long-term services for more than 120 days.
Q. How do providers join the network?
A. Providers can fill out the following "Join the ArchCare Provider Community" form or call the Provider Service line at 1-800-373-3177 or 1-855-467-9351 and speak to a representative. Questions? Send an email to firstname.lastname@example.org.
Q. How long does is the credentialing process?
A. The credentialing process can vary and it depends on if all required documentation is received and verified. We always like to give best and worst case scenario of 90 to 120 days. Of course, sometimes this can be done much earlier.
Q. Can a Physician, Hospital, Nursing Home and Home Care Agency complete one credentialing application for all of ArchCare Plans?
A. Yes, if the services offered are part of the benefit package of the Plans. There are different benefit structures, which is described in the following resources:
- ArchCare Advantage Quick Reference Guide
- ArchCare Senior Life (PACE) Quick Reference Guide
- ArchCare Community Life Quick Reference Guide
The ArchCare Community Life plan does not accept credentialing applications for hospital, primary care physicians and specialists, such as cardiologist, orthopedic, etc.
Q. Is there a list of services that need authorization for all ArchCare Plans?
A. Yes, the list of services needing is located on the following guides:
This information is also provided in the “New Provider Welcome Package” and Provider Manual. You can also call the Provider Relations Service Line 1-800-373-3177 or 1-855-467-9351 or email email@example.com. All authorization telephone and fax numbers are included on all printed requests.
Q. What is the timely filing for claims?
A. Claims timely filing is based on your contract with the Plans. Generally, the rule is for this to be negotiated prior to execution of the contract. Non-par claims submission is 120 days from the date of the service. Timely Claim Submission Providers should submit all claims within thirty (30) days of the date of service for prompt adjudication and payment. When claims are submitted later than the time period set forth in the Provider’s agreement with ArchCare Community Life, the claim will not be paid except under certain circumstances. In no event will ArchCare Community Life pay claims submitted more than one year from the date of service.
Q. Can a provider submit paper claims and if so where should they be sent?
A. Although paper claims are accepted, they are discouraged; all participating providers are required to submit 95% of all claims electronically ID# 27034. Address Paper Claims: Plan Name (ArchCare/Advantage/Community Life/Senior Life) c/o Peak TPA: P.O. Box 21631 Eagan, MN 55121.
Q. Can a participating ArchCare Provider refer a member to a non-participating specialist?
A. Yes, but ArchCare always would prefer that a participating ArchCare Specialist is used, hospital, nursing home or home care agency is used. In rare incidents where the services are with non-participating providers, the Care manager will initiate a Single Case Agreement. Network Development will contact the non-participating entity to verify the entity is not on the Exclusion list, licensed and negotiate a rate for services.