For Providers

For information on TRICARE reimbursement, please reach out to provnetwork@svcmcny.org to discuss the reimbursement terms of your contract.

Go to our website, and click on “locate a provider.” You may use “no preference” under located field and search by the provider’s first and last name, and then select find a provider. If the provider is credentialed with us, the provider along with their practice locations will populate.

Complete provider application here and submit the form to:  ProvNetwork@svcmcny.org with a copy of your current W9. 

Please be sure provider’s CAQH is current with the following supporting documentation: 

• Attestation 
• Certificate of Insurance
• CV
• CDS (if applicable) 

*Please note: USFHP does not credential Physician Assistants (PA) or Nurse Practitioners (NP)  unless they are managing their own independent panel of patients.   If a PA/NP will be working under the supervision of a physician, we will affiliate the PA/NP to the group TIN for billing, but they will not appear on the directory.

If you have any questions, please e-mail us at ProvNetwork@svcmcny.org.

Please allow 90-120 days for the documents to be reviewed and processed. Upon completion, you will receive a welcome packet informing you of the effective date along with other useful resources.

USFHP does not credential Occupational Therapists, Physical Therapists, Behavioral Health Providers, Chiropractors, or Acupuncturists.  For questions on how to credential any of these specialty types, please contact the following vendors directly: 

Ortho-Net (Optum Physical Health) is USFHP plan’s partner administrator for outpatient Occupational/Physical Therapy benefits. For more information on OrthoNet, visit their website or contact by phone: (844) 356-4901. 

Magellan is USFHP’s plan partner administrator for behavioral healthcare. For more information on Magellan, visit their website or contact by phone: (844) 356-4901. 

Optum- (Chiropractic/Acupuncture/Massage Therapy Providers) For more information on these benefits, please visit their website  or contact (844) 356-4901.

We at USFHP want to ensure that our members and providers have the best experience possible when attempting to obtain authorization for services. To submit a request for service, fill out the Medical Necessity Review/Prior Authorization Request Form and fax it to 866-337-8690.

Sign into your Provider Portal Account Select “Forms & Resources,” and then select “Request to Update Demographic Information.” Open the PDF Demographic Form to make the necessary updates and then add it to the attachments. All demographic updates should include a W-9. Once completed, submit the form for processing. You may also access the form here.

Instructions on how and where to submit an appeal will be provided on the denial letter and/or EOB. The appeal must be in writing and must be submitted to the Plan within 90 (ninety) calendar days of the initial denial or issuance of the EOB. The appeal should include all documentation that supports your position.

The appeal must be in writing and must be submitted to ProvNetwork@svcmcny.org or US Family Health Plan 530 7th Avenue New York, NY 10018  within 30 business days.

Records should be faxed directly to US Family Health Plan: (917) 819-5854 or emailed encrypted directly to US Family Health Plan: MRRequests@svcmcny.org – Attention Quality Management. Please note an emailed document cannot exceed 200 pages (if email option is selected you may have to send in multiple emails). eDelivery direct to CIOX Health and/or MRO are acceptable if your organization participates in either of these medical record repositories.

Go to https://provider.usfhp.net/    Log into your provider portal account. On the homepage, select “Register or Update your EFT Information” and fill out all required fields.

Referrals are not pre-authorizations and must be obtained from the member’s PCP or approved specialist. The referral should be to a participating provider. Participating providers are listed on the Provider Locator . The Outpatient Referral Form can be downloaded from our website or you can use your prescription pad. Referrals are valid for 6 months from date of referral (1st visit must be within 90 days). Non-emergent out-of-network services require an authorization and a referral.

US Family Health Plan is the secondary payor to all commercial plans. USFHP is also primary to Medicare unless members with Medicare part B have End State Renal Disease (ESRD). Please refer to Section 7, page 17 in our Provider Manual, for more information on Coordination of Benefits.

For more information on how to become a provider with USFHP please reach out to the Provider Network team at ProvNetwork@svcmcny.org