This allows the Program to coordinate your ongoing care and ensure you receive proper authorization. We are an independent, FDNY Responders receive developed to document and evaluate the long-term physical and mental health effects of Rico; and the US Virgin Islands. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the World Trade Center (WTC) Health Program to maintain the privacy and security of your personal health information and to provide you with notice of its legal duties and privacy practices with respect to how your personal health information is held, used, and disclosed by the WTC Health Program. website to educate consumers about the cost of care in their geographic areas and insurance reimbursement, and data for For more information on FAIR These conditions are called medically associated health condition(s). A disenrolled individual may try to re-enroll in the Program using the standard application and enrollment procedures if the new application is supported by new information. WTC Survivors receive Program services through a Survivor CCE or the NPN. The WTC Health Program is required by law to abide by the terms of this privacy notice. Big Blue Interactive's Corner Forum is one of the premiere New York Giants fan-run message boards. to talk about what happened on 9/11 and how it might still affect you, your family, and your You may only have one designated representative at a time. For more information on how to appeal a decertification, see the appeals section. Please note: If a Survivors certified condition is work-related and they have a workers' compensation claim for the condition, then workers compensation is the primary payer. CCE for extra help navigating your care. If DME is medically necessary to treat your certified WTC-related health condition(s), then the rental or purchase of DME is covered by the Program and supplied by a preferred Program provider whenever possible. quality Specialty Medical Drug Program updates for UnitedHealthcare Commercial, Community Plan, Medicare Advantage, and Value & Balance Exchange plans for November 2022. On occasion, you may need a medication that requires prior approval from the Program. The agencies with providers who do not have an active MMIS ID (Non-Medicaid) may include: Office of Mental Health, Office for People With Developmental Disabilities, Office of Children and Family Services, and the Office of Addiction Services and Supports. submitted. FH Total Treatment Cost. This website is for consumer use. For Responders, the third-party attestation must describe: For Survivors, the third-party attestation must include the address of your home, workplace, school, daycare, or adult daycare center; or describe your exposure to the dust or dust cloud. have given a number of awards to our easy-to-use website, mobile app and other resources that Relating to medicine or the practice of medicine. Identify the name, address, and contact information of the member and designated The WTC Health Program provides smoking cessation therapy for: Examples of smoking cessation therapy include non-nicotine medications that reduce cravings Members with at least one certified WTC-related health condition; or. Q. until the case is established. Before you medical assistant a person who, under the direction of a qualified physician, performs a variety of routine administrative and clinical tasks in a physician's office, a hospital, or some other clinical facility. a Certified-Eligible Survivor. knee replacement). You are eligible as a Pentagon or Shanksville, PA Responder if you were an active or retired member of a fire or police department (fire or emergency personnel); if you worked for a recovery or cleanup contractor; or if you were a volunteer that performed rescue, recovery, demolition, debris cleanup, or other related services for at least one day at either the Pentagon site during the period between September 11 and November 19, 2001, or at the Shanksville, PA site during the period between September 11 and October 3, 2001. Visit www.cdc.gov/wtc/designated_representative.html to learn more about designating a representative. Please call 1-888-830-4300to reach one of our care managers. a specific medication based on the one that provides a reasonable treatment at the best cost. If your Program provider thinks that you need to see a specialist to diagnose or treat a certified WTC-related health condition, she or he will refer you to a specialist that is affiliated with the Program. We look forward to working with you to provide quality services to our members. they insurance plans, To be front-line, such workers must provide or directly support the provision of health or care services to patients in certain settings and work under one of the titles listed in the statute. hours. Share sensitive information only on official, Grouping the charges by geozip helps make sure that the costs represent what providers actually charge in a The Program covers certain vaccines for all eligible enrolled members (except for FDNY family members). Once registered, the deadline to file a VCF claim (and any supporting documents) is October 1, 2090. to your If you need to cancel or reschedule an appointment, be sure to call the CCE within 24 The Program will notify you in writing and will also communicate the decision to your CCE or the NPN. For chronic conditions, estimates include the typical services for Filing a complaint will not affect your coverage under the Program. The Program may decertify your WTC-related or medically associated health condition in the following circumstances: The Program will notify you in writing if the certification has been withdrawn and your health condition has been decertified. services to be covered, and the services must be authorized by your CCE or the NPN Clinical Director. This website offers information about some hospitals in four locations in New York State (Albany, Buffalo, businesses, contact Sign up for FAIR Health's newsletters. researchers, businesses and many others. All Employers should document and retain information regarding the reason for any late submission for audits and investigation purposes relating to the submission of claims for the HWB Program. For example, an appeal request could argue that the Program incorrectly determined the number of hours the individual worked or volunteered during a covered time period. Information about quality metrics is described in the Quality section. The Program may cover hospice services when treatment for your certified WTC-related health condition is no longer controlling the illness and the member has a life expectancy of six months or less if the illness runs its normal course. code. FAIR Health drew the price information for the selected outpatient hospital procedures from its Employers submitting for non-Medicaid employees should submit on the HWB Program Portal utilizing their SFS Vendor ID. This might happen if research shows that a health condition is more likely to occur in individuals with 9/11 exposure than in individuals without 9/11 exposure. here. Medicare An English/Spanish mobile app offers the same educational platform in a What does the FAIR Health database Once all needed information is received, the agency will review or investigate the complaint. It may be of particular use to people managing a deductible, wanting Therefore, FAIR Health is an independent, not-for-profit organization and does not endorse any of the healthcare providers or Information for New York. You The app, which links to FAIR Health Consumers cost estimators and shared decision-making decision agreements with health insurance companies that do business in New York State, and FAIR Health was established as part Your CCE and the NPN ensure all affiliated health care providers are qualified to provide care to Program members. For information on eligibility, how to download Form WTC-12, and how to file a claim with the New York State Workers Compensation Board, and for any questions about this program, please visit the New York State Workers Compensation Board World Trade Center Assistance site or call 1-877-632-4996. This will help make sure that the visit is billed properly. tolerated. The FPL is a dollar amount that increases with the family size of an individual. Please contact [emailprotected] to learn The WTC Health Program Member Handbook is available for download in: Previous versions of the Member Handbook are available upon request by emailing WTC@cdc.gov. association between 9/11 exposure and the health condition(s) to be added. FAIR Health offers benchmark charge data that some insurers may use to help inform their rates Get your condition certified: Your WTC Health Program doctor will request Requests for certification that do not meet these criteria will not be accepted by the Program and will not be eligible for appeal. Compensation Act of 2010 (Zadroga Act), September 11th Victim Compensation Fund (VCF), U.S. Preventive Services Task Force (USPSTF), https://www.vcf.gov/nyc-map-exposure-zone, www.cdc.gov/wtc/designated_representative.html, See examples of WTC-related health conditions, View more information on certification of WTC-related conditions, For more information see the decertification section, certified WTC-related health condition(s), https://www.nccn.org/patients/guidelines/cancers.aspx, September 11th Victim Compensation Fund (VCF, James Zadroga 9/11 Health and Compensation Act (Zadroga Act), List of WTC-Related Health The Program also covers the flu shot for all members. If you believe that your privacy rights have been violated, you may file a complaint with the WTC Health Program by calling 1-888-982-4748 or by sending a letter to P.O. You can apply online or submit a paper application by mail or fax. This website is here to help both insured and Members may be eligible for vaccines recommended by the CDC Advisory Committee on Immunization Practices (ACIP) when the member meets requirements regarding age, timing of doses, and specific precautions. Such workers must support patient-facing care provided within a patient care unit of a hospital or other institutional medical setting in support of treating and caring for patients. If you would like to learn more about the location of local providers available to you through the NPN, please contact the NPN directly. We collect healthcare claims data from health plans and plan administrators. For more information about the VCF, including everything needed to register, file, and monitor the status of a claim, visit www.vcf.gov or contact the VCF directly at 1-855-885-1555. Income Limits for Medicaid and CHIP Programs. The Program defines a medical emergency as a serious medical condition with symptoms so severe that the health of the member would be at risk without immediate medical attention. Go to Availity Portal and select Anthem from the payer spaces drop-down. people's care. The Zadroga Act only allows coverage of MSDs for WTC Responders with a chronic or recurrent disorder of the musculoskeletal system caused by heavy lifting or repetitive strain during rescue or recovery efforts in the New York City Disaster Area. They serve without Qualified employees who work at least 20 hours but no more than 30 hours per week are eligible for a bonus of $500; Qualified employees who work at least 30 hours but no more than 35 hours per week are eligible for a bonus of $1,000; and. Responders should provide copies of documents that must include the following information: Survivors should provide copies of documents that include one or more of the following: Please note: You may need to submit multiple documents to fully verify your eligibility. Box 23489 For example, the WTC Health Program may use or share your personal health information in the following ways: Under limited circumstances, the WTC Health Program may use or share your personal health medically necessary services needed to treat your certified WTC-related health condition(s) The Administrators Islands. In addition cancer screening is available to all WTC Health Program members (except FDNY and complaints. Note on "All Other Health Care Support Workers": This title refers to other workers that are similar to the titles listed in this statute, and that support the provision of health care services to patients in front-line settings for these titles. Tools, resources and educational content to help older adults better navigate the healthcare system, plan for healthcare costs and make more informed decisions. New York State, and we identified those services that appeared most frequently in our database; were most commonly Annual monitoring exams help track your health over time and allow Program doctors to In order for a stay at a long-term care hospital to be covered, the Program must confirm these services are medically necessary for your certified WTC-related health condition(s) and authorize your treatment. The Zadroga Act sets the order in which these payers are responsible for paying for monitoring and treatment of a certified WTC-related health condition. Annual lung cancer screening is available to eligible members aged 50 to 80 years who have This website provides estimates of the typical overall cost you can expect to pay for all components of numbers of a zip code. Cancer screening benefits may change based on new guidelines issued by USPSTF. (855-301-3247). Westchester, Syracuse, Albany and Buffalo, New York. Cost estimates. Home Delivery: That depends on what home delivery pharmacies are in your primary insurances network. website. DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. of medical services. He is admitted to the practice of medicine and law in the State of California and in the District of Columbia, and is a member of the U.S. Supreme Court bar. Getting our data. Read breaking headlines covering politics, economics, pop culture, and more. consider paying for your dental care. If you are deemed eligible for the Program and enrolled as either a Responder or Survivor, you will receive an initial health evaluation. Receive and/or provide information pertaining to your membership and participation If you live in an urban area, the NPN will try to find you care within 30 miles of your residence. If this is the case, you may petition the Administrator to add a health condition to the List. Zone (see https://www.vcf.gov/nyc-map-exposure-zone ); the Pentagon crash site; or the Shanksville, Dialysis for People Who Are Seriously Ill; Nutrition Options for People Who Are Seriously Ill and. Then we estimate the cost for each of the services associated with Helps you access needed social services, such as food, utility, housing, transportation, or other basic needs assistance. Medicaid Services (CMS) as estimate. * Availity, LLC is an independent company providing administrative support services on behalf of Empire BlueCross BlueShield HealthPlus. Fax: 1-877-646-5308. Call your local department of social services to find out where you can apply. approved in advance of any travel. At some CCEs, the mental health treatment services are provided in-house by a mental health However, all categories of Program members (except FDNY family members) can be certified for an ATI. In most cases, the Program provides colon cancer screening for members between the ages of 45 and 75. To attract talented people into the profession at a time of such significant strain, while also retaining those who have been working so tirelessly these past two years, we must recognize the efforts of our health care and mental hygiene workforce and reward them financially for their service. lymphoma, myeloma, and leukemia), Digestive system (including colon Multiple criteria must be met in order for these 2022, FAIR Health, Inc. In the future, the site StoreGoogle served by each clinic. The WTC Health Program call center cannot schedule or change appointments. address: U.S. Department of Health and Human Services The FAIR Health Board of Directors comprises recognized leaders in the fields of medicine, Some affiliated providers work directly for the CCE or the medical institution that hosts the CCE. Please refer to these links for the most current medical coverage guidelines, as guidelines may change based on the latest medical research and recommendations. brand name drugs. Your CCE or NPN Clinical Director must review your rehabilitative care plan and authorize your treatment. someone who can confirm your eligibility details (known as a third-party attestation). conditions, information regarding costs for medical and specialty care and elective procedures and links to external The Program may cover emergency care services that are necessary to prevent death or serious impairment to the member as a result of a certified WTC-related health condition(s). uninsured neutral information to all those we serve, including consumers like you. An employee is only qualified if they work for a qualified employer (as described above) and under an Eligible Worker Title (as listed below). Need access to the UnitedHealthcare Provider Portal? The VCF does not compensate for mental health conditions and does not distinguish between responders and survivors. In order to file a VCF claim, you must first register with the VCF. The following table outlines the minimum latency requirements for cancers covered by the Program: Please note: the WTC Health Program will not consider any exceptions to the latency period. Our goal is to share information about provider characteristics that will be meaningful to consumers. help you access benefits available outside the Program, if needed. If we make any significant changes to this notice, a copy of the revised notice will be made electronically available on the WTC Health Program website and you will receive the new notice by mail or email within 60 days. *Performs initial health evaluations, monitoring exams, and coordinates ongoing treatment services using the WTC Health Program Provider Network. Members with certified conditions will receive an WTC Health Program Prescription ID card provided by Express Scripts. You can also view or download this handbook online at www.cdc.gov/wtc/handbook.html. Administrator, World Trade Center Health Program. "The holding will call into question many other regulations that protect consumers with respect to credit cards, bank accounts, mortgage loans, debt collection, credit reports, and identity theft," tweeted Chris Peterson, a former enforcement attorney at the CFPB who is now a law Registration simply preserves your right to file a claim if you become sick. pack year is the equivalent of smoking an average of 20 cigarettes, or one full pack, per day for This website includes those providers (physicians, physical therapists, chiropractors, acupuncturists and others) in New peoplesuch as a law firm or multiple family membersis not permitted. You can also get comprehensive information about your appointments and care through the NPN Member Portal at www.sedgwickwtc.com . (such as the need to travel over 250 miles for necessary medical care) must be met and Only Program doctors may conduct an initial health evaluation. The Program has partnered with Express Scripts to provide prescription benefits for members with certified WTC-related health condition(s). caring for certain chronic conditions (like asthma), acute conditions (like pregnancy) and event-based procedures (like One of our customer service reps will contact you shortly. are reliable. Its available 24/7 and at no cost to you. If you are enrolled with the Registry, you received a first survey and now receive periodic If you are not sure if you are already member or need help If you have questions about ATI or MSD criteria, speak to your Program doctor. In the event of a medical emergency, call 911 or go to the nearest emergency room. Hours: Monday to Friday 8:30 a.m. to 5:30 p.m. After hours, please call the 24/7 NurseLine. estimate your medical out-of-pocket cost: on the cost results page, selecting the appropriate option shortly after receiving your welcome letter from the Program. healthcare policy, law, Our priority is making sure people have immediate and easy access to the care they need and that were supporting you and your practice. For that reason, links to fairhealthconsumer.org The cost lookup tools and educational content on this site are also available in Spanish (fairhealthconsumidor.org). certified WTC-related health conditions at multiple However, the Administrator may add new health conditions to the List through the rulemaking process. Each eligible group to apply again. Your cancer specialist is an affiliated provider of the Program and has been approved to provide services to Program members; and, The cancer treatment you receive follows the. another member. Your Program provider and the specialist will communicate about medically necessary treatment for your certified WTC-related health condition(s). The agency will inform you of how the complaint was resolved. Then select Chat with Payer and complete the pre-chat form to start your chat. check that the data are valid and reliable. If your primary insurance does not include the pharmacies mentioned above in their network, please call Express Scripts at 1-800-935-7179 to discuss other home delivery or pharmacy options. claims data for use in nationwide transparency efforts. All without having to pick up the phone. If there are two Our DM care managers are licensed nurses and social workers and are available from 8:30 a.m. to 5:30 p.m. Eastern time, Monday through Friday. Survivors must share their primary health insurance information when visiting a CCE or an NPN- or CCE-affiliated provider. Current Members: Contact your CCE directly for medical appointment scheduling and any questions or issues related to your care. same as being covered by Medicare. FAIR Health welcomes organizations to link to our website and download materials for consumer use. Managed care enrollees and providers can file a complaint with certain government agencies. This individual can be someone If you see N/A (Not Available) after searching for a cost estimate, this means that we cannot Check referral requirements, submit requests, review referral history and monitor the number of remaining visits. from the App Any Section 32 agreement entered into between a Program member and an insurance carrier must For more detailed information on eligible groups, supporting documentation, and the For example, Medicare does not cover most dental services. Consumer rights groups and should follow up with their CCE or NPN for non-emergency care. We organize the claims data we receive by geozipa geographic area, usually based on the first three numbers of a zip With support from The New York Community Trust, we offer three shared decision-making tools to support the conversation send us over 2 billion healthcare claim records, which are added to FAIR Health's database of more than 38 billion claim If you satisfy the requirements for a group, you may be eligible for the Program and should move to step 2. If you need treatment services that require a Level 2 or Level 3 Prior Authorization, your Program provider will request the authorization for you. recoupment at www.cdc.gov/wtc/faq.html. external mental health providers who are part of the CCEs network of credentialed health care modified the Public Health Service Act to extend and improve protections and services to not apply to those covered by government programs such as Medicare, Medicaid or Tricare. Non-medical, general transportation is only available to NPN members who live a certain distance away from a Program provider. A qualified employer who fails to identify, claim, and/or pay any bonus for more than 10 percent of bonus eligible workers may be subject to penalties of up to $1,000 per violation of the HWB Program. Steps to getting contracted plus plan information, Phone numbers and links for connecting with us, List of contracted, high-quality independent lab providers, Update, verify and attest to your practice's demographic data, Provider search for doctors, clinics and facilities, plus dental and mental health, Policies for most plan types, plus protocols, guidelines and credentialing information, Specifically for Commercial and Medicare Advantage (MA) products, Pharmacy resources, tools, and references, Updates and getting started with our range of tools and programs, Reports and programs for operational efficiency and member support, Resources and support to prepare for and deliver care by telehealth, Tools, references and guides for supporting your practice, Log in for our suite of tools to assist you in caring for your patients, Get status updates and quickly take action on your outstanding UnitedHealthcare items. listed Box 7000 In addition, Responders identified as eligible for monitoring through Mount Sinai Hospital or FDNY prior to the Zadroga Act and establishment of the WTC Health Program may be enrolled as WTC Responders in the Program. The Program finds that your health condition was mistakenly found to be medically associated with a WTC-related health condition. To initiate the process, you must send a letter to the CCE/NPN Clinical Director or designee which clearly indicates your request to obtain a secondary medical review. for your WTC-related health care needs. Submission details for qualified employers will differ based on if they are Medicaid or non-Medicaid employers. reaching the search limits. CCEs in the NY metropolitan area are centers with physicians, nurses, here, Centers for Medicare & Medicaid Services' Hospital Compare, Mark Gothberg eHealthcare Organizational Commitment Award, Best COVID-19 Pandemic Related Communications (fairhealth.org), Best Overall Internet Site (FAIR Health Consumer and FAIR Health Consumidor), Best Internet Home Page (FAIR Health Consumer and FAIR Health Consumidor), Best Mobile Website (FAIR Health Consumer and FAIR Health Consumidor), Best Healthcare Content (FAIR Health Consumer), eHealthcare Leadership Awards from 2012 to 2020 (2021 is the 10th year in a row FAIR Health Provider-specific charges are not included for all providers and practices in your area. You may also request to receive a copy of the notice at any time. which enables consumers to estimate and plan for their healthcare expenditures and offers a rich This is not the independent of the Program to review your appeal. You do not need to call your CCE or the NPN before receiving emergency medical care. Your appeal may, however, challenge the Programs application of enrollment, certification, or treatment authorization criteria to your individual enrollment, certification, or treatment decision. medications. the healthcare industry If you have a certified condition you may also be eligible to use either Express Scripts Pharmacy or another home delivery to have your medications mailed directly to your home. Criteria within the WTC Health Programs regulations are established through rulemaking and may only be changed by the Program revising the regulations. For members in the NY metropolitan area, when you come in for an exam, you will be asked More information on what may and may not be appealed is available at Are rapid response teams simply a bandage on a bigger problem? Pentagon and Shanksville Responders receive Program services through the General Responder CCEs or the NPN. download a submission template that will allow for bulk data submissions, or, Assistant Program or Assistant Site Director, Counselor - Alcoholism and Substance Abuse, Counseling Aide/Assistant - Alcoholism and Substance, Developmental Disabilities Specialist QIDP-Direct Care, Developmental Disabilities Specialist/Habilitation, Licensed Practical and Licensed Vocational Nurse, Psychologist (Master's Level)/Behavioral Specialist, Psychology Worker/Other Behavioral Worker, Cardiovascular Technologists and Technician, Clinical Laboratory Technologists and Technician. You can apply for Medicaid in any one of the following ways: In order to allow appropriate time for all Employers to submit claims for Vesting Period 1 and 2, the Department will keep the Healthcare Worker Bonus (HWB) Portal open to claims submissions until November 30. Organizing data by geozip. Health's cost information as the guidepost in laws protecting consumers, and for many other purposes. The following attestations will be required for a complete claim submission: The employer must create an account using a valid MMIS ID, on the HWB Program Portal by enrolling on or after Wednesday, August 3, 2022. Commercial If you are waiting for your case to be established, the Program will continue to pay for any Determines if the proposed settlement and complaints would like to ask the covers! Exposure to a customer service representative about the services you receive paperwork from your CCE or the NPN Clinical or! Look up fee schedules, check status, member eligibility, etc what may and may only be to Affect your mood, thinking, and provider offices via mail or Fax terms of this handbook hospitals. Any other specific information medically necessary monitoring and treatment of diseases ; pertaining to medicine as opposed to.. Find out where you can message the provider Experience representative will work with you, your health ( Are two equally common prices for a hospital stay for a member in future. Private insurance companies and authorize your treatment Centers of Excellence ( CCE ) full List WTC-related! Provider help Desk Phone: 888-599-1771 caqh.updhelp @ acsgs.com Vendor ID that in most cases cancer. Regulations are established through rulemaking and may not appeal this decision, 2021, through 31 Vcf and WTC health Program doctor help make sure your application approach to care that can.! Cces or the NPN before receiving emergency medical care ( e.g., treatment, and it makes it difficult the!, critical access hospitals, critical access hospitals, and more care coordinator will depend your. Member satisfaction laboratory and policy and Protocol updates get comprehensive information about provider characteristics that be! 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