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Step 1 (Required Unless Exempt) - National Provider ID (NPI) - Before enrolling in the NYS Medicaid Program most providers must apply and receive an NPI from the National Plan and Provider Enumeration System website. A list of provider types that do not need an NPI can be found on the emedny.org website.
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Step 2 (Required) - The Enrollment Application: A NYS Medicaid Enrollment Application must be submitted by a prospective provider. The completed application will be reviewed by NYS Department of Health. The determination will be sent to the provider, in writing, upon approval or denial of the application. If more information is necessary to process the application, the provider will be notified as to what information is needed and where to send it. If the application is approved, the provider will be notified of his/her provider ID Number and the effective date when services may be provided to an enrolled client.
- The Provider ID Request Form may be located by going to emedy.org, click on Information, then click on Provider Enrollment Forms, then click on the appropriate form for your provider type. (Or, click here.)
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Step 3 (Required) – Provider Manuals: Before rendering service to a client, providers need to become familiar with the policies and procedures of the Medicaid Program which are located on the emedny.org website.
- Select Provider Manuals from the main menu. (Or click here: http://www.emedny.org/ProviderManuals/index.html.)
- For providers who choose to bill electronically, there are Companion Documents that describe how the electronic transaction must be formatted based on HIPAA requirements. The documents are located on the emedny.org website, under the NYHIPAADESK tab, then, choose eMedNY Companion Guides and Sample Files. (Or, click here: http://www.emedny.org/hipaa/emedny_transactions/transactions.html.)
- In addition to the provider manuals and companion guides, NYS Medicaid publishes a monthly newsletter known as the Medicaid Update. The newsletter is available on the New York State Department of Health website. The Medicaid Update highlights changes to Medicaid policy and procedures and should be reviewed by providers each month.
- To view the NYS Medicaid Update, go to the NYSDOH website (http://www.health.state.ny.us/), click on Medicaid, then Medicaid Update. (Click here to go directly there.)
- The Medicaid Update is also available electronically. The newsletter will be delivered monthly to your designated email address in a Portable Document Format (PDF). To receive the Medicaid Update electronically, please send your email address along with your MMIS Provider ID Number to the following email address: medicaidupdate@health.state.ny.us.
Those providers who cannot receive the Update via email may send a written request, along with Provider ID Number, to the following mail address:
NYS Department of Health,
Office of Health Insurance Programs,
Attention: Medicaid Update Editor,
Corning Tower, Room 2029,
Albany, New York 12237
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Step 4 (Required) – Client Eligibility Verification: Providers must verify the eligibility of the client via the Medicaid Eligibility Verification System (MEVS) and to obtain a Service Authorization (SA), if required, before rendering service. The MEVS manual located on the emedny.org website and considered part of the provider manual, gives detailed instructions for the available methods for verifying eligibility and the meaning of messages returned by MEVS. MEVS will verify eligibility for any current or past date and give information about clients who are enrolled in Medicaid Managed Care plans or who have Medicare or other insurance coverage. If other coverage exists for the client, the provider will need to bill the other insurance first as Medicaid is the Payer of Last Resort.
- To locate the MEVS Manual, go to emedny.org, click on Provider Manuals, click on MEVS Manual, then, you will see a choice of a PDF document or HTML path for a MEVS Manual. (Or, click here.)
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Step 5 (Required) – Electronic/Paper Transmitter Identification Number (ETIN): Prior to submitting claims, a provider must submit an ETIN application along with a notarized Certification Statement. These forms along with their instructions can be found on the emedny.org website or may be obtained by calling the eMedNY Call Center at 1-800-343-9000. Before submitting these forms, the provider’s enrollment application must be approved, as the assigned provider number is required before completion of these forms.
- To locate the ETIN application form, go to emedny.org, click on Information, click on Provider Enrollment, then click on Electronic/Paper Transmitter Identification Number (TSN/Provider). (Or, click here.)
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Step 6 (Optional) – Prior Approval: Certain services require prior approval (PA) by the appropriate NY State or county office before a claim can be submitted. Please review the provider manual specific to your provider type to obtain information regarding PA requirements. If PA is required, there are various methods for submitting a PA request. Paper PA forms are available to enrolled providers by calling 1-800-343-9000. Electronic PA requests may be submitted via ePACES (see below – Step 8) or through software purchased from a vendor/software company.
- (NOTE: A list of vendors is available on the emedy.org website. Select NYHIPAADESK from the main menu, and then select Vendor Information. (Or, click here.) There, you will find a list of companies from whom you can purchase services. The list will detail the types of transactions the company supports, such as the 278 Request for PA which complies with HIPAA regulations.)
Rosters showing the outcome of your PA requests will be mailed to you unless you sign up to receive these rosters electronically. To sign up for receiving PA rosters electronically in PDF format, first sign up for ePACES, then complete the request form.
- The Prior Approval Roster Request Form is available at emedny.org, under Information, eMedNY Paper Forms, Prior Authorization Forms. (Or, click here.)
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Step 7 (Optional) – Electronic Funds Transfer (EFT): EFT for Medicaid payments is currently optional for enrolled providers. EFT allows Medicaid funds to be automatically transferred to a provider’s chosen bank account and eliminates mail time. The EFT application and complete instructions are located on the emedny.org website.
- To locate the EFT form, go to emedny.org, click on Information, Provider Enrollment, and finally, Electronic Funds Transfer (EFT) Enrollment Form. (Or, click here.)
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Step 8 (Required) – Claims Submission: Providers are given several options for submitting claims to the NYS Medicaid Program. Most providers today submit claims electronically. In fact, approximately 97% of claims submitted to the Medicaid Program are sent in an electronic format. Electronic claim transactions that are currently processed by eMedNY are the 837 Professional (837P), the 837 Institutional (837I), the 837 Dental (837D) and NCPDP (pharmacy claims). Details for electronic claim submissions are below:
- Electronic claims must be submitted in a HIPAA-compliant format. Providers may choose to purchase electronic software or services from a vendor. A list of vendors is available on the emedny.org website.
- To locate the Vendor List, go to the emedny.org website, click on the NYHIPAADESK tab on the main menu, and then select Vendor Information. (Or, click here.) There, you will find a list of companies from whom you can purchase services. The list will detail the types of claims (transactions) the company supports such as Professional (837P), Institutional (837I), Dental (837D), or, for Pharmacies, the NCPDP format.
- As an alternative to paying for vendor services, many providers avail themselves of Medicaid’s FREE software call the Electronic Provider Assisted Claim Entry System (ePACES). ePACES is an internet-based program that will allow an enrolled provider to submit claims as well as many other types of transactions in a HIPAA-compliant format.
The status of claims (paid, pended or denied) submitted via the ePACES batch feature is generally available within 24 hours. For professional claims, ePACES allows for the submission of claims in “real-time”. Real-time means that the claims are processed instantaneously and the provider can view the status of a real-time claim within seconds. There is no need to wait for a remittance statement to be mailed to find out about the status of submitted claims. Today, via ePACES, providers know right away if there is a problem with the claim and, if approved, the payment amount.
Enrollment in ePACES requires a Medicaid Provider ID number and an internet address. To start the ePACES enrollment process contact the eMedNY Call Center at 1-800-343-9000. Please note that while a provider can sign up for ePACES without an ETIN, an ETIN is required before claims can be submitted via ePACES.
ePACES supports the following types of transactions:
- Claims: Professional (batch or real-time) Institutional and Dental
- Claim Status Requests
- Prior Approval Requests
- Eligibility Verification (including UT (Utilization Threshold) Service Authorizations
- Paper Claim Forms – For Providers who absolutely have no choice but to submit paper claims, there are paper claim forms available. (Note that once a provider is fully enrolled, a supply of paper claim forms will be mailed to the Provider.) Information regarding paper claims is located by clicking on Information, then eMedNY Paper Forms. Or click here.)
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Step 9 (Optional) - Remittance Options: The processing of most Medicaid transactions is performed by Computer Sciences Corporation (CSC). CSC is the eMedNY contractor for the NYS Medicaid Program. eMedNY processes transactions 24 hours a day, 7 days a week and issues checks and remittance statements weekly, for processed claims. Medicaid checks and paper remittances are held for two weeks and two days before issuing to the provider. For providers who have elected to receive electronic remittances or PDF versions of paper remittances, the remittances are not held with the check and are issued weekly after the close of the processing cycle.
Electronic remittances are issued in a HIPAA-compliant format known as the 835 or 820; therefore software is required to interpret the remittance information. Software is available from several vendors listed on the emedny.org website.
- To locate the Vendor List, go to the emedny.org website, click on the NYHIPAADESK tab on the main menu, and then select Vendor Information. (Or, click here.) There, you will find a list of companies from whom you can purchase services. The list will detail the types of Remittance Transactions the company supports such as the 835 Payment Advice or the 820 Managed Care Payment Advice.
PDF Paper Remittances
There are many advantages to receiving a PDF version of the paper remittance:
- The remittance will not be held with your Medicaid check for two weeks but released to you two weeks earlier.
- You will know when the PDF is available in your eXchange account; and you will not have to wait for the mail.
- The remittance can be downloaded and stored electronically for ease of retrieval and you can still print a hard copy.
- The remittance can be word searched to help locate specific claims.
- The PDF will look exactly like the paper remittance with which you are already familiar.
- Remittances can be printed with Adobe Reader® (6.0 release or higher required) which is available free of charge.
In order to receive the New York Medicaid paper remittance advice in a PDF format through eMedNY eXchange, click here.
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INQUIRIES: Questions should be directed to the CSC Call Center at 1-800-343-9000. Before submitting claims, providers may also phone the Call Center to request training from a CSC Regional Representative.
Thank you for your interest in enrolling in the New York State Medicaid Program.
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