November 30, 2023Attention: A DME and Pharmacy Provider Communication is Now Available
The following provider communication has been posted for DME and Pharmacy Providers:
Enteral Nutrition Pricing Increase
- November 20, 2023
Attention: Electronic Visit Verification (EVV) Update for PDN Provider
An important update regarding EVV is available at the link below. The update pertains to both Licensed Home Care Services Agency (LHCSA) PDN providers and Independently Enrolled RN and LPN PDN providers: https://www.health.ny.gov/health_care/medicaid/redesign/evv/2023-11-13_pdn_comm.htm
Additional information regarding EVV can be found at: https://www.health.ny.gov/health_care/medicaid/redesign/evv/
Questions regarding EVV can be directed to EVVhelp@health.ny.gov
Questions regarding PDN can be directed to OHIPMEDPA@health.ny.gov
- November 17, 2023
Attention: A Dental Provider Communication is Now Available
Clinical Criteria Guidance to Updated Dental Medicaid Dental Benefits Effective 1/31/2024
- November 16, 2023
Attention: It's almost time for HealthHelp's Provider Satisfaction Survey
HealthHelp's Provider Satisfaction Survey is going out to providers and facilities beginning November 28, 2023.
As a user of Consult, specialty benefits management services administered by HealthHelp, your feedback is vital for improving our processes. HealthHelp provides easy ways for you to obtain authorizations: through our online web application, fax, phone authorization through our call center, and IVR automated touch phone system. We would like your input on any of the methods you have used to contact HealthHelp.
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 28th. We look forward to hearing from you!
- November 8, 2023
Attention: A Dental Provider Communication is Now Available
Updates to the New York State Medicaid Program Dental Policy and Procedure Code Manual
- October 26, 2023
Attention: Clarification to Durable Medical Equipment, Orthotics, Prosthetics and Supplies (DMEPOS) Fiscal Order Acceptance Policy
The following clarification is being made to the DMEPOS fiscal order policy. The documents that are acceptable for a fiscal order have not changed, but clarification has been added for the following:
- Facsimile or electronic orders are acceptable for validation of a telephone orders
- Steps necessary by providers if verification of a telephone order is not provided by the ordering practitioner
Click Here to Read More
- October 24, 2023
Attention: Pharmacy Billing Guidance for Brand Name Drugs with New Generic Launches
All new drugs to market are subject to clinical and fiscal review by NYRx, the Medicaid Program, for formulary placement and prior authorization requirements. The review process may occasionally cause a delay between newly launched generic drug market availability and NYRx coverage activation. During this time, pharmacists should continue to utilize the brand name drug with an appropriate Dispense-As-Written (DAW) code, in NCPDP field 408-D8. This guidance does not supersede the prescribing provider’s designation of "DAW", if indicated.
Click Here to Read More
- October 3, 2023
Attention: Update Regarding Accu-Chek® Guide Test Strips compatible with MiniMed (Medtronics) Insulin Delivery System, HCPCS A4253
The Accu-Chek Test Strips that are compatible with the MiniMed Insulin Delivery System and Accu-Chek Blood Glucose Monitor are not part of the Preferred Diabetic Supply Program for NYRx, the Medicaid Pharmacy Program. Effective October 1, 2023, using code A4253, select providers can directly bill for these strips via professional claim type. All other providers will need to submit for prior approval (PA). Prior approval requests can be submitted electronically through ePACES or mailed in on a paper PA Form.
Requests for HCPCS A4253 for test strips that are compatible with glucometers with voice synthesizers will continue to require prior approval. Documentation requirements for these test strips as outlined in the DMEPOS Procedure Code manual are still in effect.
Click Here to Read More
- October 2, 2023
Attention: Updated Continuous Glucose Monitoring Criteria
Effective October 1, 2023, NYS Medicaid criteria for Continuous Glucose Monitoring (CGM) has changed. The Department has revised the insulin criteria requiring frequent adjustments. The criteria now only specify that members with a diagnosis of type 1 or type 2 diabetes must have an insulin treatment plan or insulin pump. Frequent adjustments are no longer a criterion for CGM. This represents an expansion of NYS Medicaid coverage and alignment with current national coverage standards. Billing for CGM has not changed.
Click Here to Read More
Complete the EFT Form