The following provider manuals and fee schedules have been updated for April 1, 2015:
Clinical Psychology, Clinical Social Worker, Laboratory, Midwife, Nurse Practitioner, Pharmacy, Podiatry, Rehabilitation Services, and Vision Care.
Effective January 22, 2015, per the 2014-15 enacted budget, a new pharmacy early fill edit will be implemented that will tighten early fill parameters based on days’ supply on hand in an effort to further reduce overutilization, stockpiling and/or diversion of drugs.
Federal regulation 42 CFR, Part 455.414 requires New York State Medicaid to revalidate your enrollment every five years. Revalidation involves completion of the enrollment form and submission of all required documents.
Clinics include: Ambulatory Surgery Centers, Diagnostic and Treatment Centers,
The Department of Health is pleased to announce some enhancements being made to ePACES beginning on January 23, 2015. The enhancements are being made in response to a request made by some of our provider community to allow more efficiency when entering multiple Dispensing Validation System (DVS) requests for the same client.
Providers, Medicaid beneficiaries and Medicaid Managed Care Organizations (MMCOs) were notified in the October 2014 Medicaid Update that New York State Medicaid fee-for-service and Medicaid Managed Care were eliminating coverage of topical oxygen wound therapy (TOWT) effective December 1, 2014 and January 1, 2015, respectively.
The New York State Department of Health has released Information applicable to providers servicing beneficiaries in need of emergency fills of prescriptions or fiscal orders (including prescription and over the counter drugs and medical supplies) when a State disaster emergency has been determined by State or Local officials. This guidance will only be in effect until the State disaster emergency has ended.
On July 28, 2014 eMedNY opened the Provider Testing Environment (PTE) for submitters to begin testing Medicaid claims with ICD-10 diagnosis codes. In addition inpatient hospital claims that utilize ICD-10 procedure codes may be tested beginning on this date.
Date of Service Requirement
When submitting test claims with ICD-10 codes submitters must use a date of service of July 1, 2014 or any date of service up to the date of the test submission. Future dates are not allowed. Submitters who may be testing claims with ICD-9 codes must use a date of service prior to July 1, 2014.
Effective January 1, 2014, FFS Medicaid will implement new FFS claims editing requiring Medicaid FFS enrollment for ordering/prescribing/referring/attending (OPRA) physicians and other healthcare professionals. If the ordering professional is not enrolled, under federal law Medicaid must deny the claim for the ordered service.
ATTENTION: MEDICAID NOW REQUIRES ALL BILLING PROVIDERS TO REGISTER FOR ELECTRONIC FUNDS TRANSFER (EFT) PAYMENTS AND EITHER ELECTRONIC REMITTANCE ADVICE (ERA) OR PDF REMITTANCES.
Billing providers who have not registered for EFT and ERA or PDF remittances will not be allowed to re-certify their Electronic Transmitter ID Number (ETIN). When the ETIN expires a provider's claims will be rejected by eMedNY. It is therefore very important that providers who have not registered for EFT and ERA or PDF remittances do so right away. Waiting for your ETIN to approach expiration will jeopardize your payments.
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