Provider and Pharmacy Network

Provider and Pharmacy Directory

The Provider and Pharmacy Directory includes information about the provider and pharmacy types in RiverSpring Health Plans’ network and listings of all the plan’s providers. The listings contain provider and pharmacy address and contact information as well as other details, as applicable, such as days and hours of operation, specialties, and skills. Key terms and their definitions appear in alphabetical order in the last chapter of the Evidence of Coverage.

 Disclaimers

  • This Directory lists health care professionals (such as doctors, nurse practitioners, and psychologists), facilities (such as hospitals or clinics). We also list the pharmacies that you may use to get your prescription drugs.
  • We will refer to these groups as “network providers” in this Directory. These providers signed a contract with us to provide you services. This means they accept members of our plan and provide services our plan covers.
  • This is a list of RiverSpring Health Plans’ network providers for the following plans and counties:
    • RiverSpring Star (HMO I-SNP): Bronx, Kings, New York, Queens, Richmond, Nassau and Westchester.
    • RiverSpring MAP (HMO D-SNP): Bronx, Kings, New York, Queens, Richmond, Nassau, and Westchester.
  • You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services at 1-800-771- TTY/ TDD users should call 711, 7 days a week from 8 a.m. to 8 p.m. ET.
  • The list is updated frequently, but you need to know that:
    • Some RiverSpring network providers may have been added or removed from our network after this Directory was published.
    • Some RiverSpring providers in our network may no longer be accepting new members. If you are having trouble finding a provider who will accept new members, call Member Services at 1-800-771-0088. TTY/ TDD users should call 711, 7 days a week from 8 a.m. to 8 p.m. ET.
    • To get the most up-to-date information about RiverSpring’s network providers in your area, call Member Services at 1-800-771-0088. TTY/ TDD users should call 711, 7 days a week from 8 a.m. to 8 p.m. ET.

Choosing a Primary Care Provider (PCP)

You can get services from any provider who is in our network and accepting new members.

When you become a member of our plan, you will choose a PCP who is part of our plan network. This provider will be your PCP.

If you did not choose a PCP or would like to make a change to your PCP, go to the list of providers and choose a provider:

  • that you use now, or
  • who has been recommended by someone you trust, or
  • whose offices are easy for you to get to.

If you want help in choosing a PCP, please call Member Services at 1-800-771-0088. TTY/ TDD users should call 711, 7 days a week from 8 a.m. to 8 p.m. ET.

Choosing a Primary Care Dentist

You will be assigned a Primary Care Dentist by our dental benefits manager, Healthplex, Inc.  All covered services must be provided by a participating dentist.

If you have questions about your dental benefits or want to change dentists, please call Healthplex at 1-800-468-9869. TTY/TDD users should call 1-800-662-1220, 24 hours a day, 7 days a week. For a dental emergency, please call your dentist’s office or Healthplex at 1-800-468-9868. TTY/TDD users should call 1-800-662-1220.

When you call to set up your first dental appointment, be sure to inform the dentist’s office that you are a RiverSpring Health Plan member.

How to Identify Providers in RiverSpring’s Network

You must get all your covered services from providers within our network. If you go to providers who are not in RiverSpring’s network (without prior authorization or approval from us), you will have to pay the bill.

A prior authorization is an approval from RiverSpring before you can get a specific service, drug, or see an out-of-network provider. Riverspring Star (HMO I-SNP) and RiverSring MAP (HMO D-SNP) may not cover the service or drug if you don’t get approval.

The exceptions to this rule are when you need urgent or emergency care or dialysis and cannot get to a provider in the plan, such as when you are away from home. You can also go outside the plan for other non-emergency services if RiverSpring gives you permission first.

  • You may change providers within the network at any time during the year. If you have been going to one network provider, you do not have to keep going to that same provider.
  • RiverSpring works with all the providers in our network to accommodate the needs of people with disabilities. As applicable, the list of network providers in this Directory includes information about the accommodations they provide. If you need to see a provider and are not sure if they offer the accommodations you need, RiverSpring can help you. Talk to your care teamfor assistance.

How to Access Out-of-Network Providers

Out-of-network providers are providers that are not in the RiverSpring network. If you need care that our plan covers and our network providers cannot give it to you, you can get permission from RiverSpring to get the care from an out-of-network provider. Contact Member Services at 1-800-771-0088. TTY/ TDD users should call 711, 7 days a week from 8 a.m. to 8 p.m. ET.

How to Access Specialty Providers

You can get additional information about how to access specialty care by calling Member Services at 1-800-711-0088. TTY/ TDD users should call 711, 7 days a week from 8 a.m. to 8 p.m. ET.

  List of Network Providers

This part of the Directory includes a list of RiverSpring’s network providers who participate in and accept RiverSpring members. It contains:

  • Health care professionals Health care professionals and support providers including primary care providers, specialists, adult day services, social day care, consumer-directed personal assistance services, home-delivered and congregate meals, home health agencies, environmental modifications, home maintenance services, non-emergency transportation, independent living skills and training, moving assistance, personal care services, personal emergency response services, private duty nursing, respite services, and home and community support services;
  • Facilities including hospitals and nursing facilities;
  • Support providers including adult day services, consumer-directed services, home-delivered meals, and home health agencies.

You may get services from any of the providers on this list.

The RiverSpring Provider directory contains:

  • 131 Ancillary Providers
  • 44 Hospitals
  • 7,766 Specialists
  • 525 Long-term Services and Supports
  • 1,989 Primary Care Physicians
  • 1943 Dentists*
  • 68 Skilled Nursing Facilities
  • 3379 Pharmacies

*Dental providers are not covered by the RiverSpring Star (HMO I-SNP) benefit package.

Background Information about RiverSpring Health Plans’ Network Pharmacies

The Provider and Pharmacy Directory provides a list of pharmacies in RiverSpring’s network. These network pharmacies are pharmacies that have agreed to provide prescription drugs to you as a member of the plan.

For up-to-date information about RiverSpring’s network pharmacies in your area, please call Member Services at the number at the bottom of this page.

To get a complete description of your prescription coverage, including how to fill your prescriptions, please read the Evidence of Coverage and RiverSpring’s List of Covered Drugs (Formulary).

  • Please visit RiverSpringHealthPlans.org for a list of drugs covered in the RiverSpring Star formulary.
  • Please visit RiverSpringHealthPlans.org for a list of drugs covered in the RiverSpring MAP formulary.

Types of Pharmacies in RiverSpring Health Plans’ Network

Along with retail pharmacies, your plan’s network of pharmacies includes:

Mail-order pharmacies send covered prescription drugs to members through the mail or shipping companies. To get information about filling your prescriptions by mail call Member Services Pharmacy Helpdesk at 1-855-898-1482 to request a copy of the mail order form. TTY/ TDD users should call 711, 7 days a week, 24 hours a day.

  • Home infusion pharmacies prepare prescription drugs that are given through a vein, within a muscle, or in another non-oral way by a trained provider in your home.

Long-term care (LTC) pharmacies serve residents of long-term care facilities, such as nursing homes.

You are not required to continue going to the same pharmacy to fill your prescriptions. You can go to any of the pharmacies in our network. To learn more about mail order pharmacies, see Chapter 5 of the Evidence of Coverage or call the Member Services Pharmacy Helpdesk at 1-855-898-1482. TTY/ TDD users should call 711, 7 days a week, 24 hours a day.

Long-Term Supplies of Prescriptions

  • Mail-Order Programs. We offer a mail-order program that allows you to get up to a 90-day supply of your prescription drugs sent directly to your home. A 90-day supply has the same copay as a one-month supply.
  • 90-Day Retail Pharmacy Programs. Some retail pharmacies may also offer up to a 90-day supply of covered prescription drugs. A 90-day supply has the same copay as a one-month supply.

Last updated on December 5, 2019