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Provider Enrollment > Audiologist
Audiologist - Individual Billing Medicaid
If you Do/Will Provide Medical Services and Bill Medicaid Click here for the Enrollment Form and Instructions.
Audiologist - Order/Prescribe/Refer/Attend ONLY
If you ONLY will Order/Prescribe/Refer/Attend and you will NOT be Billing Medicaid, Click here for the Enrollment Form and Instructions.
Audiologist - Change From OPRA To Billing Provider
If you are already enrolled as an Order/Prescribe/Refer/Attend (OPRA) Provider and wish to provide Medicaid Services and Bill Medicaid, Click here for the Enrollment Form and Instructions.
REMINDER: Beginning on April 1, 2021, per the article in the October 2020 Medicaid Update, the Medicaid Pharmacy Benefit will be transitioned to the Fee-for-Service program (aka the Pharmacy Carve Out). Pharmacies, Prescribers and Durable Medical Equipment Prosthetics, Orthotics and Supply (DMEPOS) providers must be enrolled in the FFS program as billing providers in order to continue to serve Medicaid Managed Care members.
PHARMACIES AND PHARMACY BASED DURABLE MEDICAL EQUIPMENT, PROSTHETIC, ORTHOTIC AND SUPPLY (DMEPOS) PROVIDERS Category of Service (COS) as listed on the enrollment form as Free Standing Pharmacy (COS 0441) or Free-Standing Pharmacy Based DME (COS 0442).
Pharmacies must be appropriately enrolled as a FFS billing pharmacy and/or pharmacy based DMEPOS provider. This means that pharmacies providing prescription and over-the-counter (OTC) drugs, medicalsurgical supplies, enteral and parenteral formula and/or hearing aid batteries must be enrolled as Medicaid FFS billing providers. Information regarding the DMEPOS that are subject to the carve-out can be found at: https://www.health.ny.gov/health_care/medicaid/redesign/mrt2/pharmacy_carve_out/docs/rx_carve_out_scope.pdf
If you do not enroll in FFS as a billing provider or you are only enrolled in Medicaid in a non-billing status, pharmacy claims for Medicaid Managed Care members that are submitted to the Medicaid FFS program will be denied starting April 1, 2021. To become an FFS billing pharmacy, you must also enroll in Medicare as a participating provider. We suggest beginning the Medicaid and Medicare enrollment processes as soon as practicable to mitigate potential delays in the ability to bill Medicaid.
In addition to being enrolled in Medicare, your pharmacy must have an actively enrolled Supervising Pharmacist affiliated with it.
In order to continue to serve New York State Medicaid Managed Care members, prescribers who are initiating prescriptions or fiscal orders for drugs or supplies are subject to the carve-out and will also need to enroll in FFS. Prescribers can choose to enroll in FFS as either "Individual Billing Medicaid" (also known as Individual Biller) or as Ordering/Prescribing/Referring/Attending (OPRA) non-billing providers. To find all required information and documentation needed to submit an enrollment application,