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| Frequently Asked Questions
(FAQ) |
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The FAQs provided on this site are constantly updated as new questions
are added or as appropriate responses are updated with the latest
information. Please check back frequently for any questions you
may have. If you have a question that you feel should be included
here, or if you feel any of the answers provided are incorrect,
please let us know.
Select a question topic:
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Copayment |
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| Q: |
How do I know when
a recipient's co-payment maximum
has been met? |
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| A: |
The MEVS will give
the response "COPAY Met" and the date it
was met. |
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Dispensing Validation System |
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| Q: |
What are the three
extra fields required when
performing a DVS transaction on Tran Type "6"? |
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| A: |
The MEVS will display
three (3) additional prompts when
Tran Type "6" is chosen. Those are "COS" (Category
of Service), "ENTER ITEM/NDC#", and "ENTER QUANTITY". |
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Drug Utilization Review |
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| Q: |
Will I get paid
if I override this claim? |
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| A: |
If the information
you enter on your transmission is accepted
by the eMedNY system, but other edits find problems on the
claim, then it may still pend or deny. |
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| Q: |
What does "Maximum
Quantity Exceeded" mean? |
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| A: |
The quantity that you
are entering for the prescription is
greater than what New York allows for dispensing. |
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| Q: |
Can I have the
name of the pharmacy that filled the
prescription that is conflicting with mine? |
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| A: |
Unfortunately, we are
unable to provide you with that information. |
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Eligibility Verification |
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| Q: |
Can the Provider
Services Unit check the patient's
eligibility for me? |
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| A: |
Providers providing
services for New York recipients are required
to check eligibility on MEVS using one of the following access
methods. The available methods are: the telephone verification
system, the point-of-service terminals, the NYS Eligibility
software,
direct PC-Host and CPU-CPU. |
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| Q: |
How do I perform
a telephone verification? |
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| A: |
Perform the steps below:
- Convert the Recipient ID Number
to all numerics
- Dial the telephone number
- Once the connection is made,
an Audio Response Unit
(ARU) will prompt you for the input data needed
- If you need a prompt repeated,
press "*"
- To bypass a prompt, press "#"
- Once you are familiar with the
prompts and wish to make
entries without waiting for the prompts, continue to enter
the data in the proper sequence. Press the "#" key after
each entry.
- For some prompts, if the entry
is invalid, the ARU will
repeat the prompt.
- Call is terminated if excessive
errors are made
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| Q: |
What does "Not
MA Eligible" mean? |
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| A: |
The patient is showing
no New York Medicaid eligibility for
the service date requested. |
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Pharmacy Claims |
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| Q: |
How do I enter
an out-of-state license number in the
ordering provider field? |
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| A: |
Choose the appropriate
3-digit license type from the list in the
MEVS Provider Manual. After entering the license type, enter
the 2-digit alpha state code, followed by the license number.
*(For ARU Transactions, the alpha state code needs to be
converted prior to being entered.) |
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| Q: |
How does a pharmacist
override a drug conflict code
of "DD" (Drug to Drug Interaction) or "TD" (Therapeutic
Drug Duplication)? |
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| A: |
In order to process
a DUR override, the same code that
was returned as the denial code (Drug Conflict Code), must
be placed in the DUR Conflict Code Field. The DUR Conflict
Code being sent as the override must match the DUR Conflict
Code received in the response of the original transaction. The
override of "1A" through "1G" must be sent in the DUR
Outcome Code Field. For example, "1A" = "Filled as is, false
positive". |
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| Q: |
My Pharmacy claim
pended for manual pricing.
What should I do? |
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| A: |
For questions regarding
Pharmacy claims pending for manual
pricing, contact NYS DOH at (800) 562-0856. |
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Post and Clear |
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| Q: |
What does "Service
Not Ordered" mean? |
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| A: |
If the ordering provider
is designated as a Post and Clear
provider, they are required to post the number of lab or
pharmacy items they are ordering. The Lab or Pharmacy
must then clear the services ordered. "Service Not Ordered"
means the ordering provider did not post the number of
services ordered. The Lab or Pharmacy must then contact the
ordering provider to request that the services be posted. |
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POS Terminals |
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| Q: |
How do I reset
the day/date/time? |
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| A: |
In order to reset the
day/date/time, perform the following
steps:
- Press the "*" (asterisk) key
and the "3" key at the
same time
- Press the "ALPHA" key
- Enter the appropriate number
corresponding to the
day of the week:
- "1" = Monday
- "2" = Tuesday
- "3" = Wednesday
- "4" = Thursday
- "5" = Friday
- "6" = Saturday
- "7" = Sunday
- Press the "FUNC/ENTER" key and
enter the last two
(2) digits of the year
- Press the "FUNC/ENTER" key and
enter the appropriate
number corresponding to the month of the year
- "1" = January
- "2" = February
- "3" = March
- "4" = April
- "5" = May
- "6" = June
- "7" = July
- "8" = August
- "9" = September
- "10" = October
- "11" = November
- "12" = December
- Press the "FUNC/ENTER" key and
enter the number
for the day of the month
- Press the "FUNC/ENTER" key and
enter the hour
- Press the "FUNC/ENTER" key and
enter "0" for
AM or "1" for PM
- Press the "FUNC/ENTER" key and
enter the minutes
- Press the "FUNC/ENTER" key and
enter the seconds
- Press the "FUNC/ENTER" key and
the new
day/date/time will be displayed
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Service Authorizations |
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| Q: |
How long does a
UT Service Authorization stay on file? |
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| A: |
For Pharmacy claims,
the service authorization will remain on
file for ninety (90) days. For Physician/Clinic, Lab, Dental
Clinic
and Mental Health Clinic claims, the service authorization will
remain on file for one hundred twenty (120) days. |
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| Q: |
What does "At Service
Limit"/"Nearing Limits" mean? |
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| A: |
The patient is currently
at their service limits for UT service
authorization. To increase the patient's limits, a practitioner or
clinic needs to file a Utilization Threshold override application.
Nearing limits means that the patient is close to the standard
limits that have been afforded them at the beginning of their
anniversary year. |
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Third Party / Other Insurance |
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| Q: |
Do I bill the other
insurance or Medicaid first? |
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| A: |
If the other insurance
covers the service that you are
rendering, they would be first to be billed. Medicaid would
be last to be billed if other insurances are involved. |
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Cycle Processing Calendar |
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| Q: |
What is eMedNY's processing schedule? |
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| A: |
Click here for the Cycle Processing Calendar. |
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Other Common Inquiries |
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| Q: |
What does "Eligible
PCP" mean? |
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| A: |
"Eligible PCP" means
the recipient is enrolled in a prepaid
capitation or managed care plan. The plan code and coverage
codes are returned in the response. Review the coverage
codes to determine exactly what services are covered by the
plan. Code explanations can be found in the billing section
of
all MMIS provider manuals and the MEVS Provider Manual.
For further details as to what benefits are covered by the plan,
contact the recipient's Managed Care Plan. |
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| Q: |
What does "No Cov
Excess Income" mean? |
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| A: |
"No Cov Excess Income"
means that the recipient has an
income in excess of the allowable levels, or a "spenddown".
A spenddown is an amount, determined by the local County
Department of Social Services, that the recipient must incur
each month before eligibility can be established. Once the
spenddown has been met, the file will be updated to reflect
that month's eligibility. |
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| Q: |
What is the current
sequence number for the patient? |
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| A: |
A sequence number is
a fraud control measure within New
York State. Unfortunately, we are unable to provide you with
that information. It is the responsibility of the patient to
provide
you with their most current card provided them by the NYSDOH. |
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| Q: |
What if I have a change of address? |
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| A: |
It is the responsibility of the provider to notify Medicaid of any change of address or other pertinent information within 15 days of the address change.
Fee for Service providers can obtain more information on where to direct address change requests by going to http://www.emedny.org/info/ProviderEnrollment/index.html and clicking on Fee for Service Address Change Form.
Rate based providers can obtain more information on where to direct address change requests by going to http://www.emedny.org/info/ProviderEnrollment/index.html and clicking on Rate Based Change of Address Form.
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| Q: |
I'm a recipient
and have a question, can you help me? |
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| A: |
Unfortunately, we are
unable to assist you at our customer
service line unless your question is specifically about the
Medicaid Override Application System (MOAS) or you
received a letter alerting you that an increase in services has been
granted. Please contact your local department of social
services or human resources administration office for any other
Medicaid eligibility issues. |
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