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Please complete this information in full. The effective date
of your
enrollment cannot be earlier than the date a complete application
is
received by the Department. If additional information must
be
requested to complete the enrollment package, the date of
enrollment
will be the date the package is complete.
You will be at financial risk if you render service to
Medicaid
patients before successfully completing the enrollment process.
Payment will not be made for any claims submitted for service,
care or supplies furnished before the enrollment date
authorized by the Department.
When you are enrolled in the program, you will receive a
letter informing
you of your Medicaid Provider identification Number and the
effective date
of your enrollment. Each month you will receive a Medicaid
Update which
will detail important billing and program information. The
Medicaid Update
may also be accessed on the DOH website, www.health.state.ny.us,
by
clicking on Provider Info, Medicaid, and finally Medicaid
Update. Articles
are available from 1997 through present.
You may obtain the Provider Manual, which contains New York
State
Medicaid policy, a list of information sources, and billing
instructions from
this web site.
New York State Medicaid Regulations allow the Department
90 calendar
days after receipts of a complete application to determine
whether to enroll
an applicant in the program. To allow us the opportunity to
process your
application, please allow 90 days before you call to inquire
about the status
of your application.
If you have any questions, contact Computer Sciences Corporation
at
(800) 343-9000.
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