March 17, 2023Attention: Medicaid Fee-for-Service Providers Dispense Brand Name Drug when Less Expensive than Generic Program
Please see the update to the Dispense Brand Name Drug When Less Expensive Than Generic
Program for changes effective March 31, 2023.
- March 14, 2023
Attention: Updated PDN Provider Manuals
The 2023 Private Duty Nursing Policy Guidelines and Procedure Code Manuals have
been updated. Any changes reflected in the manuals are effective for dates of service
beginning April 1, 2023.
Highlights of the update include:- Clarification of PDN policies, procedures, and documentation requirements
- Information regarding the Medically Fragile Children and Adult Program
- Links to PDN Provider Directories
- Information regarding PDN fees set by DOH
Questions related to the revised manuals can be directed to the Office of Health Insurance Programs at OHIPMedPA@health.ny.gov. Billing related questions can be directed to eMedNY at (800) 343-9000.
- March 9, 2023
Attention: 2023 NYS Medicaid Dental Policy and Procedure Code Manual and Updated Fee Schedule
The 2023 Manual and updated Fee Schedule are now available on eMedNY.
Updated guidance documents include:
- 2023 Dental Policy and Procedure Code Manual
- Updated Fee Schedule
- Change Summary Table
The revised documents are effective January 1, 2023 and may be referenced online at: https://www.emedny.org/ProviderManuals/Dental/
- March 7, 2023
Attention: Updated DME Provider Manuals
The 2023 DME Policy Guidelines, Procedure Code Manual, and DME Fee Schedule have been updated. Any changes reflected in the manual are effective for dates of service
beginning April 1, 2023. Questions related to coverage criteria and guidelines can be directed to the Office of Health Insurance Programs at OHIPMedPA@health.ny.gov. Billing related questions can be directed to GDIT at (800) 343-9000.
Click Here to access the manuals.
- March 3, 2023
Attention: The Enteral Web Portal is live as of March 2nd, 2023.
- February 8, 2023
Attention: NYS Medicaid Enteral Prior Authorization Enhancements - Web Portal Launch and Training Sessions
The New York State Department of Health, Office of Health Insurance Programs, Bureau of Medical Review will be launching a new web portal for enteral formula authorizations. The portal will allow entry of information by practitioners and dispensing providers directly into a web portal rather than using a telephonic interactive voice response (IVR) system. The current telephonic IVR will still be available and can continue to be utilized for authorizations. The web portal and IVR will work interchangeably, and an authorization can be completed if practitioners and dispensing providers use different entry methods.
Click here for detailed information.
- January 13, 2023
Attention: An Updated DME Provider Communication is Now Available
The document, "Correction-2023 Coding Changes for Continuous Glucose Monitoring" effective January 1,2023 has been posted.
Click here to access the document.
- January 12, 2023
Attention: Medicaid Fee-for-Service Providers Dispense Brand Name Drug when Less Expensive than Generic Program
Effective 1/19/2023, the following changes will be made to the Dispense Brand Name Drug When Less Expensive Than the Generic Program:
- Glumetza will be ADDED to the program
Click Here to Read More
- December 12, 2022
Attention: Medicaid Pharmacy Benefit Transition - MU Special Edition
Effective April 1, 2023, NYS Medicaid members enrolled in mainstream Medicaid Managed Care (MMC) Plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plans (SNPs) will receive their pharmacy benefits through the NYRx Pharmacy program instead of through their MMC Plan. The pharmacy benefit transition to NYRx does not apply to NYS Medicaid members enrolled in Managed Long-Term Care (MLTC) Plans [e.g., MLTC, Programs of All-Inclusive Care for the Elderly (PACE), Medicaid Advantage Plus (MAP), the Essential Plan, or Child Health Plus (CHP)]. Transitioning the pharmacy benefit from MMC to NYRx will provide NYS with full visibility into prescription drug costs, allow centralization of the benefit, leverage negotiation power, and provide a uniform list of covered drugs with standardized utilization management protocols simplifying and streamlining the drug benefit for NYS Medicaid members. NYS Medicaid consumers have comprehensive drug coverage and equitable access to an extensive network of over 5,000 pharmacy providers.
For more information on the Medicaid Pharmacy Benefit Transition please see the New York State Medicaid Update - October 2022 Medicaid Pharmacy Prescription Drug Benefit Transition Part One: Special Edition
- November 10, 2022
Attention: Help's Provider Satisfaction Survey is going out to providers and facilities beginning November 29, 2022
As a user of Consult, specialty benefits management services administered by Health Help, your feedback is vital for improving our processes. Health Help provides easy ways for you to obtain authorizations: online web application, fax, phone authorization through call center, and IVR automated touch phone system. We would like your input on any of the methods you have used to contact Health Help.
Please participate to help us improve our processes with your feedback. The survey takes about five minutes to complete.
Please help us make the most of this opportunity by encouraging participation that helps us improve the provider experience! Visit HealthHelp.com/Survey to participate. The survey link will be active beginning on November 29th. We look forward to hearing from you!
Complete the EFT Form