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  • Cdphp Form# 5862 1011

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PLEASE PRINT. For address and/or primary care physician changes call (518) 641-3700, 1-800-777-2273, or visit www.cdphp.com USE BLACK INK ONLY. Enrollment Application/ Change Form EMPLOYER USE ONLY.

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Claims must be submitted in a timely fashion, generally no more than 90 days from the date of service. Please refer to your CDPHP participating provider agreement for full information. What is the address for a provider office to submit claims? The claims address is: CDPHP, P.O. Box 66602, Albany, NY 12206-6602.

If we do not approve your request for coverage, you can appeal our decision. You can submit a complaint about CDPHP Medicare Advantage directly to Medicare by calling 1-800-Medicare, or by submitting an online complaint directly to Medicare at https://.medicare.gov/MedicareComplaintForm/home.aspx.

Claim Submission Process All paper claims must be submitted to: CDPHP, P.O. Box 66602, Albany, NY 12206-6602.

Capital District Physicians' Healthcare Network, Inc. CDPHN is wholly owned by Capital District Physicians' Health Plan, Inc.

Payers Timely Filing Rules PayerTime limit to submit new claimsAmida Care90 days from date of serviceCDPHP120 days from date of serviceEmblem120 days from date of serviceeMedNY1 year from date of service (electronically)9 more rows • Apr 8, 2022

Simply enter the organization's name (CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC) or EIN (141641028) in the 'Search Term' field.

Capital District Physicians' Health Plan, Inc. (CDPHP®) – HMO, Healthy New York, Medicare Advantage (HMO), Medicaid, Child Health Plus, and Essential Plan.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232