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Providers

Our Providers Are Dedicated to High-Quality, Compassionate Care.

CommuniCare Advantage invites providers in our service areas who are committed to quality, compassionate care for members enrolled in our ISNP (Institutional Special Needs Plan) or our CSNP (Chronic Condition Special Needs Plan) to join our growing network.

Medicare Advantage plans originated in the Balanced Budget Act of 1997 passed by the U.S. Congress. Originally known as Medicare+Choice or Part C plans, they became known as Medicare Advantage Plans following the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. These plans offer a more coordinated approach to healthcare for beneficiaries than traditional fee-for-service Medicare. Special Needs Plans were also included in the legislation to address those who live in long-term care and those with chronic conditions (for CommuniCare Advantage: diabetes mellitus, chronic heart failure, and cardiovascular conditions).

ISNP. CommuniCare Advantage’s ISNP applies to residents who are living in a participating CommuniCare nursing home in selected Ohio, Maryland, and Indiana counties.

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CSNP. The CommuniCare Advantage Chronic Special Needs Plan covers individuals with diabetes mellitus, chronic heart failure, or cardiovascular disease who live in Anne Arundel, Baltimore, and Baltimore City counties in Maryland, and in Butler, Cuyahoga, Hamilton, Lorain, and Montgomery counties in Ohio.

How CommuniCare Advantage Can Benefit Providers

CommuniCare Advantage is an HMO Medicare Advantage ISNP and CSNP. We contract with a network of healthcare providers in select counties in Indiana, Maryland, and Ohio. Our Plan offers providers several benefits:

  • To have the support of case managers to help coordinate and ensure delivery of high-quality, customized care in our nursing facilities or in the community
  • To be a part of a team of medical professionals that believes in keeping members healthy through the use of care coordination and personalized patient care
  • Medicare Fee Schedule reimbursement
  • A partnership with local, community-based leaders who understand your challenges because we are providers, too

CommuniCare Advantage’s Model of Care is proactive and facilitates early evaluation and risk assessment through the following:

  • Health risk assessment and health risk stratification
  • The support of an interdisciplinary care team
  • An individualized care plan that addresses the unique goals, preferences, and clinical needs of the member
  • Proactive care coordination for ISNP members led by our primary care partner, Personalized Health Partners, at a cadence appropriate to the member’s health needs
  • Care coordination and care transition coaching as needed for CSNP members to ensure understanding and adherence to treatment plans and reduce need for rehospitalization after an acute episode of care
  • Care transition management
  • Advance care planning
  • Active engagement with the member for all decision making and planning
 

Interested in becoming a CommuniCare Advantage Provider?

Contact us at providerrelations@communicare-advantage.com.

Access Health Services Provider Portal

Effective January 1, 2026, Access Health Services began overseeing the CommuniCare Advantage provider portal. The provider portal enables providers to do several things including:

  1. Submit an authorization request
  2. Inquire about authorization status
  3. Check the status of claims/encounter information

If you have provider portal access through Access Health Services, you will not have to request additional access.

If you do not have provider portal access through Access Health Services, you must request access by submitting the AHS Provider Portal Access Request form to:

ppmanagement@accesshealthservices.com

For assistance, please contact ppmanagement@accesshealthservices.com.

Discover the benefits of CommuniCare Advantage.
Call (866) 212-4582 to learn more.