Strengthening the future for CDPHP providers and patients

CDPHP is merging with Excellus Health Plan, Inc., which currently manages health plans across 39 counties in central and western New York. When the merger is finalized, CDPHP will join Excellus Health Plan, Inc. as an additional not-for-profit health plan serving the Capital Region and surrounding areas.

Excellus Health Plan, Inc. shares our commitment of putting people first and strongly supporting the provider community. While we are merging with another organization, the CDPHP name and reputation with our providers is here to stay.

The proposed merger is planned for early 2027.

While many CDPHP programs, benefits, and processes are staying the same, we are adjusting others to better serve our members and providers. Information about changes will be shared with you throughout the year – on this webpage, and via emails, letters, and other communications.

What isn’t changing is our local identity and provider-centric approach, including the personalized attention you and your patients rely on. Founded by local physicians with a deep commitment to high‑quality, community-based health care, CDPHP will remain firmly rooted in these values.

CDPHP will still have:

• Local leadership
• Local, award-winning customer service
• In-house pharmacy program
• In-house care management program
• Member-friendly tools for cost transparency, locating providers, and more

CDPHP and Excellus Health Plan, Inc. are committed to ensuring a seamless transition for our providers and members. Enhancements that are already underway include:

• Advancing Provider Partnerships: CDPHP has long championed the development of an integrated care delivery system in upstate New York. To help further that mission, Dr. Martin Stallone was appointed as Executive Vice President, Chief Healthcare Services Officer of CDPHP and our parent company, LTHC, to focus on enhancing provider partnerships across Upstate New York.
• System Integration: We’ve made significant progress integrating the CDPHP and Excellus Health Plan, Inc. systems, allowing key business processes, including enrollment and billing, provider registry, credentialing, appeals, and more, to be connected through one common platform. Like CDPHP, Excellus Health Plan, Inc. also uses the Facets system, so our well-known support of providers will continue uninterrupted.
• Continued High Ratings: CDPHP continues to be one of the highest rated commercial and Medicare health plans in the nation, according to NCQA’s Commercial Health Plan Ratings 2025 and the Centers for Medicare & Medicaid Services Star Ratings program.
• While much of this is “behind the scenes,” our accomplishments internally will set us up for success to provide you with a positive experience externally.

Other planned improvements as part of our merger will include:

• Pharmacy benefits, including a new pharmacy benefit manager, a stronger pharmacy network, and improved pricing tools
• New member ID cards with one phone number for pharmacy and medical benefits
• A new CDPHP.com online experience
• Updates to our medical cost comparison tool
• And much more

Our pharmacy program will continue to be managed by a team of local and regional, experienced pharmacists and health care experts, ensuring we have the best programs and partners in place. Together, our teams deliver smarter pricing, broader access, and innovative programs that proactively improve outcomes and lower total cost of care.

However, it’s time to evolve our pharmacy offerings based on market needs. Soaring prescription drug costs and volatility in drug pricing models require stability and the right long-term partners for us to provide the best coverage at the lowest price. By working with Excellus Health Plan, Inc. in this area, CDPHP can build on proven models while maintaining our in-house program, local focus, and hands-on service.

While a few legacy programs are retiring, we are replacing them with stronger, more intentional solutions. These powerful, clinically guided programs—with proven results—position CDPHP to deliver a more sustainable pharmacy experience and better health outcomes for the communities we proudly serve.

Some pharmacy program enhancements that will happen in 2027 include:

• Stronger pharmacy network: Fully insured commercial and self-funded groups with pharmacy benefits administered by CDPHP will gain a stronger pharmacy network with a standard cost share model across all participating pharmacies, including CVS retail pharmacies. Standard cost share model means member pharmacy costs, like copays or coinsurance, are based on their health plan structure, instead of a preferred vs. non-preferred pharmacy network structure. This change expands members’ access to pharmacies and gives them more freedom of choice. Please note: 2027 plan-year updates for CDPHP Medicare Advantage (MA) are still in review. In line with prior years, we will update you on MA plan benefits once finalized with CMS.
•  Easier prescription drug shopping: Members will have access to real-time drug pricing through a new price check tool (replacing CDPHP ConnectRx, On the Go), making it easy to find the best drug at the best price.
• Additional mail order options: Members will continue to have access to Wegmans Mail Order, plus ConnectRx pharmacy and Express Scripts.
• New pharmacy benefit manager (PBM): Express Scripts® Pharmacy Benefit Services (ESI) will be the new CDPHP PBM. Capital Rx was the right solution years ago, and ESI is the right solution for where pharmacy is going next. Aligning with a national PBM strengthens our ability to manage rising costs, respond to market trends, and expand the solutions available to our customers.

Laterality codes on claims: Ensure that all diagnosis codes are billed with the correct laterality code (e.g., left or right side of the body, or bilateral). Learn more

National Drug Code on claims: Include the 11-digit National Drug Code on all drug and vaccine claims. Learn more

Last updated: 07/14/2026

Include taxonomy codes on all claims. Learn more

• Taxonomy codes are national specialty codes that indicate a provider’s specialty or provider type.
• When you applied for a National Provider Identifier (NPI) you selected your taxonomy code(s).
• Unsure of your taxonomy code? Submit an inquiry via the NPI Registry website.

New member ID numbers and cards: In 2027, your CDPHP patients will have a new ID card with new ID numbers to be used for all 2027 claims.

Updates will include:

• A new group ID for every commercial, self-funded, and Medicare group.
• A new member ID for every commercial, self-funded, and group Medicare member.
• Separate group IDs for medical and dental products.

Last updated: 07/14/2026

CDPHP regularly reviews our policies and guidelines to ensure that our members have access to the most current, cost-effective, and highest-quality services and treatments.

In certain cases a policy may be updated in format only, such as to revise the policy title or policy number.

When a policy is updated with changes to policy content, or when a new policy is added, affected providers are notified by letter at least 90 days in advance of the effective date of the update or addition.

Last updated: 07/14/2026

All CDPHP policies are available in the Resources section of the CDPHP provider portal.

The following categories are listed in the left-hand margin of the portal Resources section:

• Credentialing Policies
• Medical Policies
• Medicare Part D Policies
• Payment Policies
• Pharmacy Policies
• Quality & Appeals Policies

When one of these categories is selected, you will see a single PDF document at the top of the page. This PDF contains all current and future-effective policies within that category.

The PDF includes a table of contents that lists page numbers within the PDF for each policy, and the PDF is also searchable by policy name, policy number, code number, or other keyword:

• Press Ctrl and F (Windows) or Cmd and F (Mac)
• A search box will open
• Enter a name, number, or other keyword
• Use the up or down arrows in the search box to see your search results throughout the PDF

Last updated: 07/14/2026