Provider Page

Provider Demographic Form

Please use this form for demographic and/or billing changes. Please forward the completed form to the either the fax number or email address listed on the form.

Provider Manual

Provider Request

For additional information and concerns please provide us with your information and write a comment and one of our employees will call you.

Liberty Health Advantage HMO

1 Huntington Quadrangle
Suite 3N01
Melville, NY 11747
Phone: (866) 542-4269
TTY: (800) 662-1220
Office Hours: 8:00 a.m. - 6:00 p.m.

Additional Features Coming Soon!

Contact Information

Member and Provider Services

Sales Representative

Hours: 8:00AM to 8:00PM
Monday through Sunday

From February 15th through September 30th, hours are Monday - Friday only

Enrollment

Download a 2015 Enrollment Form

You may download, complete, sign and date an enrollment form. Application Instructions

Once you have completed the form please fax it to:

1-631-227-3484

Or mail it to:

Liberty Health Advantage
1 Huntington Quadrangle
Suite 3N01
Melville, NY 11747

What would you like to do now?
Picture of an Operator

Liberty Health Advantage HMO is an HMO Plan with a Medicare Advantage contract and a contract with the New York State Medicaid program. Enrollment in Liberty Health Advantage HMO depends on contract renewal.

H3337 2015 Website Approved

Last Modified: Tue, March 31, 2015 16:04:37