PAM Section 1: Introduction


On this page:

About Trinity Health Plan Of New England

Trinity Health Plan Of New England is a Medicare Advantage plan. We are a provider-sponsored organization dedicated to providing exceptional coverage, customer service and access to high quality and cost-effective care.

We are a not-for-profit organization that is a part of the Trinity Network and are contracted with the Centers for Medicare & Medicaid Services (CMS) to participate in the Medicare Advantage program offering HMO products with, and without, Part D drug coverage to Medicare beneficiaries. 

We are committed to partnering with our providers to build strong relationships and make working with us easier. We developed this manual to guide you through Trinity Health Plan Of New England policies, procedures and processes. Great effort has been made to ensure the information in these pages is accurate. If there is any conflict between the contents of this manual and your provider agreement, the provider agreement will prevail. Please contact provider services if you have any questions.

Important News and Updates to this Manual

In accordance with your agreement, providers must abide by all provisions contained in this manual, as applicable. Revisions to this manual constitute revisions to Trinity Health Plan Of New England's policies and procedures. Such revisions and other updates to policies and procedures may be communicated to network providers via the monthly Provider Update, but may also be communicated via multiple methods that may include mail, internet, email, telephone, and in person.

Provider Communications

We want to be a great partner and develop mutually beneficial partnerships with our providers. Communication is essential to successful relationships and sharing information with you is very important to Trinity Health Plan Of New England. We distribute a monthly “Provider Update” to all our participating providers. It shares key information to stay current on matters that may affect your work with Trinity Health Plan Of New England and our members.

How to Contact the Plan

Provider Service Center 
Toll Free: 1-800-991-9907 (TTY: 711) 
Toll Free Fax: 1-833-900-0607 
8 a.m. to 5 p.m. Monday – Friday

Address 
3100 Easton Square Place 
Suite 300 – Health Plan 
Columbus, Ohio 43219

Department Contact Information

Case Management 
Toll Free: 1-800-240-3870, option 5 
8 to 4:30 p.m. Monday – Friday 
Toll Free Fax: 1-833-263-4870 
Email: CaseManagement@MediGold.com

Compliance 
Toll Free: 1-866-477-4661 
Email: MediGoldCompliance@mchs.com

Contracting & Provider Relations 
Toll Free: 1-800-991-9907 (TTY 711) 
Toll Free Fax: 1-833-900-0608 
Email: MediGoldContracting@mchs.com

Member Grievance and Appeals 
Toll Free: 1-888-898-6129 (TTY 711) 
Toll Free Fax: 1-833-802-2495

Member Services 
Toll Free: 1-800-240-3851 (TTY 711) 
Toll Free Fax: 1-833-900-0606

Pharmacy Benefit Manager 
CVS Caremark Part D Services, LLC 
P.O. Box 52066 
Phoenix, AZ 85072-2000 
Phone: 1-866-785-5714

Quality Management 
Email: Quality@mchs.com

Risk Adjustment 
Local Fax: 614-234-8728 
Toll Free Fax: 1-833-978-1756 
Email: riskadjustment@mchs.com

Special Investigations Unit (for reporting Fraud, Waste, and Abuse concerns) 
Voicemail: 1-833-263-4863 
Toll Free Fax: 1-833-900-0606 
Email: SIU.MediGold@mchs.com 
Anonymous: SIU Form

Utilization Management 
Toll Free: 1-800-240-3870 
Toll Free Fax: 1-833-263-4869 

Stars and HEDIS 
Toll Free Fax: 1-833-263-4823 
Email: StarsAndHEDIS@mchs.com

TruHearing (for audiology and hearing aid services) 
Toll Free: 855-286-0550

MediGold Vision (for vision services) 
1-866-253-8963 
8 a.m. to 8 p.m., seven days per week.

Last updated: 06/2024