eMedNY Companion Guides and Sample Files

The New York State Department of Health (NYS DOH) has provided DRAFT Medicaid Companion Documents for the 837 Dental ASC X12N (004010X097A1), 837 Professional ASC X12N (004010X098A1), 837 Institutional ASC X12N (004010X096A1) Transactions and the 835 Payment/Advice Remittance ASC X12N (004010X091A1) Transaction to assist Providers, Clearinghouses and all Covered Entities in preparing HIPAA compliant transactions. These documents were prepared using the Addenda versions of each transaction. NYS DOH has focused primarily on the rules and policies regulating the submission of Medicaid data that are provided within each Companion Guide document. NYS DOH has provided the information on this website as a tool to make the Provider’s job easier in preparing electronic transactions in a HIPAA compliant manner.

NYS DOH does not offer individual training to assist Providers in the use of the ASC X12N transactions provided on this website. However, training will be offered to meet the individual needs of Providers in preparing their transactions to follow NYS Medicaid policy. Additional information regarding training dates and locations will be posted on this website as it becomes available.

The information provided herein is believed to be true and correct based on the Addenda Version of the HIPAA guidelines. These regulations are continuing to evolve, therefore NYS Medicaid makes no guarantee, expressed or implied, as to the accuracy of the information provided herein. Furthermore, this is a living document and the information provided herein is subject to change as NYS DOH policy changes or as HIPAA legislation is updated or revised.

270 Eligibility, Coverage or Benefit Inquiry 270 Companion Guide	835 Health Care Claim Payment Advice 835 Companion Guide 835 Sample Files 835 Supplementary CG 835 Sample Supplementary Files
271 Eligibility, Coverage or Benefit 271 Companion Guide 271 Sample Transaction	837 Dental Health Care Claim 837 Dental Companion Guide 837D Supplemental CG
276 Health Care Claim Request 276 Companion Guide	837 Institutional Health Care Claim 837 Institutional Companion Guide 837 Institutional Supplemental CG 837 Institutional Managed Care Capitation Premium Billing CG
277 Health Care Claim Status Notification 277 Companion Guide 277 Claim Status	837 Professional Health Care Claim 837 Professional CG 837 P Non-Emergency Transportation CG 837 Professional Supplemental CG
278 Health Care Services Review 278 Req DVS SA CG 278 Request Confirmation CG 278 Request Prior Approval CG 278 Response (Confirmation) CG 278 Response DVS SA CG 278 Response Prior Approval CG 278 Sample Transaction	National Council for Prescription Drug Programs NCPDP Request Companion Guide NCPDP Response Companion Guide
820 Payroll & Other Group Premium PMNT 820 CG 820 Sample Transaction 820 Supplementary CG 820 Sample Supplementary Files	Technical Guides eMedNY Real-time SOAP User's Guide 270-278 Taxonomy CG Technical Supplementary CG FTP Batch Procedure Instructions eMedNY Electronic Gateway / BBS User Manual eMedNY Provider Testing User Guide