NY Medicaid  
home | self help | glossary | site map

Featured Links

834 FAQs
Frequently Asked Questions
Privacy & Security
Transaction Instructions
Online Resources
EEKB Search Tool

Sign Up for

To be notified of 5010 / D.0 updates, please sign up for the eMedNY General Updates category of LISTSERV®

Helpful Links

Report An Issue


eMedNY's Headquarters for HIPAA X12 5010/NCPDP D.0

When entering this site, be sure to review eMedNYHIPAASupport What's New for the latest changes.

Important Announcements

August 23, 2021

An updated version of the eMedNY MCE 834 Companion Guide (version 2.7) is published on the eMedNYHIPAASupport page. Changes being planned with this release (October 22, 2021) focus primarily on the Recipient Restriction Exception (RRE) Information shared with the Plans.

All sample transactions within the Companion Guide are updated and can be used by the Plans for internal testing. eMedNY will NOT send any test files directly to Plans as part of this update. Text versions of all samples included in this Companion Guide are also available for download from the eMedNYHIPAASupport Transaction Instructions page. Look for these MCE 834 CG Sample Files under Managed Care Enrollment and select appropriate CG Samples.


This release will also include a change to the DMG segment (Loop 2100A). Starting on October 22, 2021, eMedNY will no longer omit the DMG Segment (Loop 2100A) when there are no demographics changes on a CHANGE transaction.

June 9, 2021

An updated version of the eMedNY MCE 834 Companion Guide (version 2.6) is published on the eMedNYHIPAASupport page. Substantial changes are being planned for this release, which include modifications to multiple Loops/Segments, addition of new reason codes, and a new sample transaction to aid in internal testing. Refer to the TI Change Summary, in the published CG, for a complete list of modification. Managed Care Plans are encourage to review the updated guidance and begin preparing for these changes outlined for the MCE 834 transaction set.

January 13, 2020

MCE 834 Test Scenarios and Samples are published on the eMedNYHIPAASupport page to aid in Managed Care Plans' internal testing of the MCE 834 transactions. All MC Plans are encouraged to review the instructions in the MCE 834 Test Scenarios & Sample Files, then use the sample files contained within this PDF for further internal testing. Of the four files included in this PDF, one is a verification/audit file, which should be processed first. The remaining three sample files are intended to simulate files received on three different days during that same month. Plans should ensure that these files are only processed within their Test Regions.

October 1, 2019

In Summer 2020, DOH will be eliminating monthly rosters from WMS and implementing a daily transmission of all enrollment information via a standard X12 834. As such, DOH is publishing a Companion Guide which provides the technical details for electronic communications and for creating electronic transactions for DOH. This guide is intended to be used along with X12 Implementation Guides, Version 005010.

Managed Care Enrollment - eMedNY Companion Guide

July 18, 2019

Providers who are creating their own software and submitting via ASC X12 270/271 shall be aware of the new codes values returned on the 271 eligibility response when the Medicaid Client has Exception Codes "A1", "A2", "I5" through "I9". Refer to the eMedNY Transaction Information Standard Companion Guide CAQH - CORE CG X12

April 30, 2018

Updates to ASC X12 834 and Supporting Documents and Managed Care Enrollment Information:

Effective immediately, the eMedNY 834 Managed Care Enrollment Companion Guide, the 834 Enrollment Information document and the 834 FAQs have been removed from the eMedNY website. New documentation will be published as they become available.

October 24, 2016

The eMedNY Transaction Information Standard Companion Guide CAQH - CORE CG X12 has been updated. This is a major revision with all information added pertinent to the X12 HIPAA transactions that was previously published in the eMedNY Transaction Information Standard Companion Guide X12 or in the eMedNY Trading Partner Information Standard Companion Guide. These two documents will be scheduled for retirement in the near future.

July 9, 2014

On July 28, 2014 eMedNY will open 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.
Click Here to read more

March 21, 2014

Medicaid Required by Federal Law to Change Electronic Remittance Delivery Date

Effective April 7, 2014 (Cycle 1911) eMedNY will no longer be permitted to make the X12 835 and the X12 820 electronic remittances available two weeks prior to release of payment. Electronic remittances will be available two days prior to the release of funds. The change is necessitated by requirements of Section 1104 of the Affordable Care Act (ACA) and the CAQH Committee on Operating Rules for Information Exchange (CORE), the authoring entity for operating rules for Electronic Fund Transfer (EFT) and Electronic Remittance Advice (ERA) transactions. Click here to read more.

December 26, 2013

Remittance Advice will be changing: In accordance with the requirements of the Affordable Care Act's Electronic Funds Transfer provisions and mandated CAQH-CORE Operating Rule 360, NYS Medicaid will report claims adjudication system edits using a revised set of Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC). Revisions to the Edit Mapping for 835 crosswalks will be posted before the first Financial Cycle of 2014, Cycle #1898.

October 31, 2013

Attention Submitters: Provide Proper EDI Contact Information to ensure that there is minimal delay if a problem is identified by eMedNY and an outbound call is necessary. Click here for details.

About eMedNYHIPAASupport

NYS Medicaid is dedicated to providing pertinent information relating to the New York State Medicaid program. All health care providers are required to submit claims electronically. This includes all health plans including private and government programs, and health care clearinghouses. We urge the health care community to become familiar with the requirements affecting eMedNY.

This site has been created for the provider community, and will be used by the NYS Medicaid program as a main source for dissemination of information and notification of all New York State Medicaid activities. This site will be updated on a regular basis in an effort to share relevant Medicaid information, its potential impact on our program and its potential impact on providers' business processes and information system. Whenever entering this site, be sure to check out our Frequently Asked Questions (FAQ's) section. We have already posted answers to many of your most common and problematic questions. We will be continuing to post new questions and answers as they arise.