NY Manual
SHP Manual

SHP Provider Manual
3.2a Sample Service Plan Letter (Page 2) | 3.2b Sample Service Plan Update Letter (Page 2)

3.2 b Sample Service Plan Update Letter (Page 1)

                                                                                                       

 
 
     

<<Date>>  

  

<<First Name>><<Last Name>>

<<Address 1>> <<Address 2>>

<<City>>, <<State>> <<Zip>> 

 

                                                                                                                                                                       Member:  <<MEM NAME>>    

                                                                                                                                                                     Member ID#: <<MEM ID>>  

RE: Service Plan Update 

Dear <<First Name>><<Last Name>>: 

This letter is to inform you that we have reviewed your request for service(s) and/or item(s). Based on your Care Team’s review of this request, it has been decided that the service(s) and/or item(s) listed below are medically necessary. Therefore, the service(s) and/or item(s) listed below are approved and will begin on the requested date.

 

If you have any additional questions, please contact your Care Management Team at<<(212) 324-2600>><<Monday – Friday 9:00 a.m. to 5:00 p.m.>>.

 

 Sincerely, 

  

 cc: provider/facility/PCP/member