NOTICE of IPA Participation Agreement,

 and Participation Agreement for the

North Shore-LIJ Employee Aetna Plans and

North Shore-LIJ Employee Empire Plan

 

 

Dear Physician/Provider                                                                 November, 2009

 

Over the past year, you may have treated employees of the North Shore Shore-LIJ Health System (NSLIJ) and/or their dependents. On behalf of Michael Dowling, CEO of NSLIJ we thank you for your high quality service to our employees, their families and the population served by the NSLIJ Health System and we hope you continue to provide services for many years to come.

 

We would now like to notify you of the opportunity to become a preferred Provider in our NSLIJ Employee Plan Network through your participation in the North Shore-LIJ Clinical Integration IPA (CIIPA), the Health System’s IPA.    As a member of CIIPA you will be invited to participate in various contract offerings. We will continue to offer future contracts on a messenger basis through CIIPA, as well as offering new opportunities to participate in new health and wellness programs, expedited credentialing arrangements, Rewards for Clinical Excellence programs, and to participate in new NSLIJ clinical integration programs.  In all cases, we will keep you informed and send you future opt-in agreements for your decision before extending your participation to any other health plan, as the opportunities arise.

 

Once you join CIIPA, the first contract offering is with the NSLIJ Employee Plans. The NSLIJ Health System currently offers four health benefit plans to its employees and their dependents: the NSLIJ Employee Empire PPO Plan, NSLIJ Employee Aetna Plus (PPO) Plan, Aetna Core Plan, and the Aetna Basic Plan.

 

All plans encourage employees to select providers who participate in CIIPA and are thereby associated with the NSLIJ System (“In-System”). Employees will have little or no co-pays or co-insurance if they select a CIIPA In-System provider. However, some plans either do not permit or have high costs associated with seeing providers outside the system. In the interest of helping to keep medical expenses for our employees as low as possible we are requesting that you send any referrals for follow-up care to a CIIPA provider and to NSLIJ System facilities.

For your convenience, a list of these CIIPA providers and NSLIJ System facilities is available at www.northshorelij.com/OpenEnrollment. Click on “Materials & Resources”, then select “Your Guide to North Shore-LIJ In-System Facilities.”  To find an in-system provider, select the custom "Aetna and Empire DocFind" links, using the above instructions. You may print out a copy for your records or save it to your files.

 

As a preferred Provider in the CIIPA network, you agree to provide services to our employees and their dependents who select any of the above plans. Regardless of which plan the employee selects you will be reimbursed at an enhanced reimbursement rate of 110% of the 2007 Medicare fee schedule and a separate enhanced fee schedule for OB/GYN services.

Text Box: The enrollment process to join CIIPA and opt-into the NSLIJ Employee Empire and Aetna Plans is simple: 1. Go to the NSLIJ webpage at www.nslij.com and click on the “Healthport” button on the top right section of the screen. 2. The CIIPA web box and 3 documents are on the top right section of the screen. 3. Complete each form following the instructions within each document.

 

 

If you have any questions, please contact me directly at ciipa@nshs.edu or at (516) 465-8808.

 

Thank you again for working with NSLIJ to provide the best care to patients in the greater New York City area.

 

Sincerely,

Phil Gautreau

Vice President, Network Development