Provider Enrollment > Medicaid Managed Care Network Provider Enrollment >Medicaid Managed Care Provider Enrollment Questions

Medicaid Managed Care Provider Enrollment Questions



CATEGORY





 

KEYWORD SEARCH

   

PRINT



Q.

How do I confirm I am actively enrolled in NYS Medicaid?

 

 

Category: General

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 01

 
 

Q.

I am not actively enrolled in NYS Medicaid. Where should I go for more information?

 

 

Category: General, Form Completion, Communications, MCO Communication

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 02

 
 

Q.

I am already actively enrolled as a NYS Medicaid fee-for-service provider. Do I have to submit another application?

 

 

Category: General

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 03

 
 

Q.

If I was previously enrolled in NYS Medicaid and am no longer actively enrolled, may I keep my original Provider Identification number (PID), also known as MMIS ID?

 

 

Category: General, Form Completion

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 04

 
 

Q.

If I am a practitioner and do not wish to enroll as a NYS Medicaid fee-for-service billing provider, is there another option?

 

 

Category: General, Form Completion

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 05

 
 

Q.

If I am an organization (e.g., business, group practice, institution) and do not wish to enroll as a NYS Medicaid fee-for-service billing provider, is there another option?

 

 

Category: General, Form Completion

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 06

 
 

Q.

Am I required to accept Medicaid fee-for-service patients when I become enrolled with NYS Medicaid?

 

 

Category: General

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 07

 
 

Q.

Why did I receive my application back in the mail?

 

 

Category: Form Completion

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 08

 
 

Q.

Our board member(s) refuse to provide their social security number. Will our enrollment be processed without this information?

 

 

Category: Form Completion

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 09

 
 

Q.

The instructions indicate an application fee is required for my category of service. Why do we have to pay the fee, what is the application fee amount, and to whom should the check/money order be payable?

 

 

Category: Fee

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 10

 
 

Q.

If I can't pay the fee, what is needed to request a hardship waiver?

 

 

Category: Fee

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 11

 
 

Q.

How will providers be notified that they are required to enroll in NYS Medicaid?

 

 

Category: Communications

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 12

 
 

Q.

May Managed Care Organziations change the sample provider outreach letter to make it plan appropriate? (i.e. MLTC instead of MMC)

 

 

Category: MCO Communication

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 13

 
 

Q.

Is there a way to prevent providers, who contract with multiple Managed Care Organizations, from receiving multiple notices?

 

 

Category: MCO Communication

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 14

 
 

Q.

Is there a list of provider types that are exempt from enrollment?

 

 

Category: Communications, MCO Communication

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 15

 
 

Q.

Will a list of enrolled providers be given to the Managed Care Organizations?

 

 

Category: MCO Communication

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 16

 
 

Q.

Will the State be providing a copy of the August 30, 2017 PowerPoint presentation?

 

 

Category: General, MCO Communication

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 17

 
 

Q.

Why am I required to enroll in NYS Medicaid if I am a Managed Care provider?

 

 

Category: General, Communications, MCO Communication

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 18

 
 

Q.

Are non-emergency transportation providers required to enroll?

 

 

Category: Other

|

Published: 10/4/2017

|

Updated: 10/4/2017

|

QID: 19

 
 

Q.

Is the FFS active provider list the same file that is downloaded from PNDS? File name = "MMIS Validation".

 

 

Category: MCO Communication

|

Published: 12/5/2017

|

Updated: 12/5/2017

|

QID: 20

 
 

Q.

Does the FFS active provider list include providers who are sanctioned by Medicaid?

 

 

Category: General, MCO Communication

|

Published: 12/5/2017

|

Updated: 12/5/2017

|

QID: 21

 
 

Q.

Can the FFS active file be updated daily as there may be issues with claims pending without daily feeds?

 

 

Category: Communications, Managed Care Network Eligibility

|

Published: 12/5/2017

|

Updated: 12/5/2017

|

QID: 22

 
 

Q.

If we contract with a business that provides nursing services, do the individual practitioners /nurses need to enroll as well as the business?

 

 

Category: Other

|

Published: 12/5/2017

|

Updated: 12/5/2017

|

QID: 23

 
 

Q.

I am required to be enrolled in Medicare as a prerequisite to enroll with NYS Medicaid but I opted out of Medicare a year ago and cannot enroll with them for another year. What should I do?

 

 

Category: General, Form Completion, Communications, MCO Communication

|

Published: 12/5/2017

|

Updated: 12/5/2017

|

QID: 24

 
 

Q.

Are pharmacies and prescribers required to be enrolled as of 1/1/18?

 

 

Category: Pharmacy/Prescriber , General

|

Published: 2/22/2018

|

Updated: 2/22/2018

|

QID: 25

 
 

Q.

If a script for a prescription drug is to be filled after 1/1/18 that is written by a prescriber without a MMIS (Medicaid ID) number, is the plan supposed to reject that claim; if this is the case, when should plans start rejecting claims from prescribers that are not enrolled?

 

 

Category: Pharmacy/Prescriber , Managed Care Network Eligibility

|

Published: 2/22/2018

|

Updated: 2/22/2018

|

QID: 26

 
 

Q.

Will members be denied their medications at the point of sale if the pharmacy provider is not enrolled by 1/1/2018?

 

 

Category: Pharmacy/Prescriber , Managed Care Network Eligibility

|

Published: 2/22/2018

|

Updated: 2/22/2018

|

QID: 27

 
 

Q.

How do we handle out of network, urgent/emergent pharmacy requests for members that are outside of our immediate service area who go to a pharmacy that is not enrolled in Medicaid?

 

 

Category: Pharmacy/Prescriber , Managed Care Network Eligibility, Communications

|

Published: 2/22/2018

|

Updated: 2/22/2018

|

QID: 28

 
 

Q.

Are the listings of enrolled pharmacy providers available and how current are such listings?

 

 

Category: Pharmacy/Prescriber , General

|

Published: 2/22/2018

|

Updated: 2/22/2018

|

QID: 29

 
 

Q.

Are providers such as Planned Parenthood required to enroll as a pharmacy since they dispense contraceptives?

 

 

Category: Pharmacy/Prescriber , General

|

Published: 2/22/2018

|

Updated: 2/22/2018

|

QID: 30

 
 

Q.

Is each pharmacy location required to enroll and have its own Medicaid ID to stay in an MCO Network?

 

 

Category: Pharmacy/Prescriber , Managed Care Network Eligibility

|

Published: 2/22/2018

|

Updated: 2/22/2018

|

QID: 31

 
 

Q.

What are the enrollment requirements for the in-state and out-of-state pharmacies?

 

 

Category: Pharmacy/Prescriber , Communications

|

Published: 2/22/2018

|

Updated: 2/22/2018

|

QID: 32

 
 

Q.

Do ordering, referring, prescribing providers that are non-par with plans but service Medicaid beneficiaries need to be enrolled?

 

 

Category: Pharmacy/Prescriber , Managed Care Network Eligibility, General

|

Published: 2/22/2018

|

Updated: 2/22/2018

|

QID: 33

 
 

Q.

Are supervising pharmacists required to enroll in the State's Medicaid program?

 

 

Category: Pharmacy/Prescriber , Managed Care Network Eligibility, Form Completion

|

Published: 2/22/2018

|

Updated: 2/22/2018

|

QID: 34

 
 

Q.

Are there exemptions, waivers or streamlined enrollment procedures for licensed non-resident pharmacies that only fill prescriptions for members participating in the State's Medicaid Managed Care program?

 

 

Category: Pharmacy/Prescriber , Form Completion

|

Published: 2/22/2018

|

Updated: 2/22/2018

|

QID: 35

 
 

Q.

What lines of business are impacted by the enrollment requirements specified in the 21st Century Cures Act?

 

 

Category: General

|

Published: 2/22/2018

|

Updated: 2/22/2018

|

QID: 36

 
 

Q.

Many plans contract for pharmacies through a Pharmacy Benefit Manager (PBM). For pharmacy providers that do not apply for a Medicaid ID, do they need to be removed from the network, or can plans just deny the claims with the message "Not a NYS Medicaid provider; please contact the Plan"?

 

 

Category: Pharmacy/Prescriber , Managed Care Network Eligibility, Communications

|

Published: 2/22/2018

|

Updated: 2/22/2018

|

QID: 37

 
 

Q.

NYS Medicaid only enrolls licensed practitioners. How should claims be paid for unlicensed residents, interns and foreign physicians that are in training programs that are legally authorized to write prescriptions, per NY Education Law under the supervision of a NY State Medicaid enrolled physician?

 

 

Category: Pharmacy/Prescriber , Other

|

Published: 2/22/2018

|

Updated: 2/22/2018

|

QID: 38

 
 

Q.

A Personal Care Agency is listed as a type of provider needing to obtain a Medicaid identification number. Licensed Home Care Services Agencies (LHCSA) typically did not have a Medicaid id number because they could not bill Medicaid. Are LHCSAs now required to obtain a Medicaid billing identification number?

 

 

Category: General, Managed Care Network Eligibility, Other

|

Published: 4/3/2018

|

Updated: 4/3/2018

|

QID: 39

 
 

Q.

For the upcoming CFCO carve-in, are non-traditional MMC providers included in this implementation?

 

 

Category: General, Other

|

Published: 4/3/2018

|

Updated: 4/3/2018

|

QID: 40

 
 

Q.

As a PACE program that exists as both a MLTC and direct provider of services, is NYS requiring the PACE organization itself to enroll or is the PACE organization only expected to operate as a MLTC in this situation, and ensure all network providers, that are providing care/services under contract, are enrolled with NYS Medicaid?

 

 

Category: Managed Care Network Eligibility, Other

|

Published: 4/3/2018

|

Updated: 4/3/2018

|

QID: 41

 
 

Q.

Do providers need to enroll that are directly hired by the PACE organization to provide services, that is, members of the interdisciplinary team (e.g., physicians, PT, OT, RN, etc.)? If yes, are they to enroll as non-billing?

 

 

Category: Form Completion, Other

|

Published: 4/3/2018

|

Updated: 4/3/2018

|

QID: 42

 
 

Q.

If a MCO has a LHCSA license for the provision of home care services but does not contract with themselves, do they enroll their LHCSA?

 

 

Category: Other

|

Published: 4/3/2018

|

Updated: 4/3/2018

|

QID: 43

 
 

Q.

Does the enrollment requirement apply to MLTC, FIDA and PACE network providers?

 

 

Category: MCO Communication

|

Published: 4/3/2018

|

Updated: 5/22/2018

|

QID: 44

 
 

Q.

Are Social Day Centers required to enroll?

 

 

Category: General

|

Published: 4/3/2018

|

Updated: 4/3/2018

|

QID: 45

 
 

Q.

For pharmacies who do not opt out and do not submit an enrollment application by 7/1/18, on if DOH does tell MCOs to terminate contracts at that point, are these pharmacies to be given fair hearing and appeals rights?

 

 

Category: General

|

Published: 5/9/2018

|

Updated: 5/9/2018

|

QID: 46

 
 

Q.

Will plans be able to execute single case agreements with providers who are not enrolled in Medicaid FFS?

 

 

Category: General

|

Published: 5/9/2018

|

Updated: 5/9/2018

|

QID: 47

 
 

Q.

Will DOH release template notices for providers and members?

 

 

Category: General, Communications

|

Published: 5/9/2018

|

Updated: 5/9/2018

|

QID: 48

 
 

Q.

Will a model letter be sent out to Plans regarding provider termination requirements for members impacted and if so, when should Plans expect this to be sent by DOH? When should the letters be sent to members impacted by the Plan?

 

 

Category: General, Communications

|

Published: 5/9/2018

|

Updated: 5/9/2018

|

QID: 49

 
 

Q.

Will the format of the provider file remain consistent going forward? Plans would like to automate a process to bump that file against plans network

 

 

Category: General, MCO Communication

|

Published: 5/9/2018

|

Updated: 5/9/2018

|

QID: 50

 
 

Q.

When will an updated pending provider list be sent out or posted?

 

 

Category: General, Communications

|

Published: 5/9/2018

|

Updated: 5/9/2018

|

QID: 51

 
 

Q.

Can the application date be added to the pending application list?

 

 

Category: General, Communications

|

Published: 5/9/2018

|

Updated: 5/9/2018

|

QID: 52

 
 

Q.

Can a LHCSA, that completes an enrollment application check off that it wants to be a billing provider AND managed care only (non- billing) if it bills managed care plans but intends to bill a county sometime in the future?

 

 

Category: General, Form Completion, Managed Care Network Eligibility, Other

|

Published: 5/9/2018

|

Updated: 5/9/2018

|

QID: 53

 
 

Q.

Does this requirement apply to fiscal intermediaries? If so, does the fiscal intermediary need to have another Medicaid provider number if it is a LHCSA and already has a Medicaid provider number (not for the fiscal intermediary)?

 

 

Category: General, Managed Care Network Eligibility, Other

|

Published: 5/9/2018

|

Updated: 5/9/2018

|

QID: 54

 
 

Q.

The 21st Century Cures Act has a deeming clause for out of state providers that provide services to NYS recipients. If the provider is enrolled in that state's Medicaid program, they are deemed to be enrolled. Why do they also need to enroll in NYS Medicaid?

 

 

Category: General

|

Published: 5/9/2018

|

Updated: 5/9/2018

|

QID: 55

 
 

Q.

Will New York State introduce new encounter edits for enrolled prescribers and/or pharmacies?

 

 

Category: General, Communications

|

Published: 5/9/2018

|

Updated: 5/9/2018

|

QID: 56

 
 

Q.

Can the Active Medicaid Fee for Service Provider file be updated to include the specialty codes used in the quarterly Provider Network Data System (PNDS) provider file?

 

 

Category: General, Communications

|

Published: 5/9/2018

|

Updated: 5/9/2018

|

QID: 57