www.eMedNY.org

Feb. 16	Attention: Ordering/Prescribing/Referring (OPR) Providers Must Revalidate for Claims to be Paid

Sept. 14	Attention: Private Duty Nursing Prior Approval Guidelines

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Complete the EFT Form		Complete the ERA/PDF Form
*Please read the EFT Form instructions carefully.* An original voided check or original signed and notarized letter from your bank is required. The tax number entered on the form must match the tax number for the provider NPI on the form. Be sure to complete all fields. Only original signed forms will be processed. NOTE: Instead of filling out the EFT Authorization Form above, you can complete the form online at: https://portal.emedny.org/provider/		*Please read theERA/PDF Form instructions carefully.* Before submitting this form providers must be registered for either an eMedNY eXchange in-box or be registered for an FTP account with eMedNY. To register for an eXchange in-box the provider must be enrolled in ePACES. The ePACES account name is the same one used for eXchange. FTP users must have submitted a Security Packet B to establish the FTP account before submitting the ERA/PDF Request form. PDF remittances look like the paper remit but are delivered via the eXchange in-box. ERAs delivered via either eXchange or FTP requires software to interpret the HIPAA-formatted information. NOTE: Instead of filling out the Electronic or PDF Remittance Advice Request Form above, you can complete the form online at: https://portal.emedny.org/provider/