GuildNet Plan Materials and Forms

GuildNet MLTC

Provider Manual English Español
Provider Directory English Español
Provider Directory Addendum
Fraud Waste and Abuse for Providers English Español
Provider Portal Instructions
Member Handbook English Español Chinese Russian
Member Handbook Update
Privacy Notice

Last Updated: 6/15/2018


GuildNet Gold

Summary of Benefits English Español
Evidence of Coverage English Español
Over-the-Counter Benefit English Español
Medicaid Advantage Plus Member Handbook
Medicaid Advantage Plus Member Handbook Complaints And Appeal Changes

Pharmacy

Formulary English Español
Formulary Changes
Medicare Part D Transition Policy
Pharmacy Quality Assurance
Medication Therapy Management Program
Medication Safety
Personal Medication List
Part D Prior Authorization Criteria
Part D Step Therapy Criteria
Pharmacy Directory English Español
Locate a Pharmacy

Forms

Medicare Advantage Enrollment Form English Español
Medicaid Advantage Plus Enrollment Form English Español
Request For Medicare Prescription Drug Coverage Determination
Request For Redetermination Of Medicare Prescription Drug Denial
Prescription Drug Claim Form
Prescription Drug Mail Order Form
New York State Health Care Proxy Form English Español
Appointment of Representative Form English Español

GuildNet Gold Provider Directory

Provider Directory: New York English Español Queens English Español Richmond English Español Kings English Español Bronx English Español
Locate a Dental Provider
Locate a Provider
Request Provider, Pharmacy Directory or List of Covered Drugs (Formulary) by Mail

Important Links and Resources

Medicare Star Ratings English Español
Grievances Appeals Organization and Coverage Determinations English Español
Low Income Subsidy (LIS) Premium Summary Chart English Español
CMS Best Available Evidence Policy
Medicare Complaint Form
Passport To Good Health Rewards Program

Provider Materials

Fraud, Waste and Abuse Training for Providers
GuildNet Gold Model Of Care
Gold Model Of Care Training
Emblem Provider Manual
GuildNet Provider Manual
GuildNet Provider Portal Instructions
Part D Authorization Portal

Policy

Policy Notice
Non-Discrimination Notice

H6864_GN655_2018 Website­_Approved
Last Updated: 9/21/18


GuildNet Gold Plus FIDA

Summary of Benefits English Español
Participant Handbook English Español
Over-the-Counter Benefit English Español

Pharmacy

List of Covered Drugs (Formulary) English
Formulary Changes
Medicare Part D Transition Policy
Part D Quality Assurance Policy
Medication Therapy Managment Program
Part D Prior Authorization Criteria
Part D Step Therapy Criteria
Can You Ask For An Exception To Cover Your Drug?
Pharmacy Directory
Personal Medication List

Forms

Part D Coverage Determination Form
Part D Reconsideration Form
Prescription Claim Reimbursement Form
Prescription Drug Mail Order Form
New York State Health Care Proxy Form English
Appointment of Representative Form

GuildNet Gold Plus FIDA Provider and Pharmacy Directory

Provider & Pharmacy Directory: New York: English Español Queens: English Español Richmond: English Español Kings: English Bronx: English
Request Provider, Pharmacy Directory or List of Covered Drugs (Formulary) by Mail

Important Links and Resources

Medicare Star Ratings English Español
Your Rights And Responsibilities Upon Disenrollment
Grievances Exceptions Coverage Determinations Appeals
Independent Consumer Advocacy Network
Medicare Complaint Form
NY Medicaid Choice
Passport To Good Health Rewards Program

FIDA Participant Advisory Committee (PAC) Meetings

GuildNet invites GuildNet Gold Plus FIDA Plan participants to participate in Participant Advisory Committee (PAC) / Town Hall / Feedback sessions, which meet quarterly.  GuildNet ensures that GuildNet Gold Plus FIDA participants have access to the FIDA PAC/Town Hall/Feedback Sessions, either in-person or remotely. GuildNet assists Participants with transportation, reasonable accommodations to meet Participants’ needs, translation services and other support to help attend the in-person meetings and light refreshments are provided. In addition, the meetings may be telephonic and at least one call focuses on family caregivers, in addition to participants. Summaries of the FIDA PAC Town Hall/Feedback sessions are available on the GuildNet website. Participants are invited to identify problems and concerns at these meetings/calls and provide positive feedback. GuildNet staff provide updates and Frequently Asked Questions (FAQs), as well as other vital information to participants.

FIDA participants interested in attending may call Participant Services at 800-815-0000 (TTY users call 711).

Virtual Meeting September 13 2018
Virtual Meeting June 7 2018
2018 PAC Meeting Calendar
Virtual Meeting March 8 2018
New York County December 7 2018
Virtual Meeting, September 7, 2017
Virtual Meeting June 8 2017
New York County March 23 2017

Provider Materials

Provider Manual
Non-Participating Provider Waiver Of Liability Statement
Part D Authorization Portal

Policy

Privacy Notice
Non-Discrimination Notice

H0811_GN654_2018 Website_Approved
Last updated 9/26/18