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Step 1 (Required Unless Exempt) - National Provider ID (NPI)
Before enrolling in the NYS Medicaid Program most providers must apply and receive an NPI from the National Plan and Provider Enumeration System website. A list of provider types that do not need an NPI can be found on the emedny.org website.
Step 2 (Required) - The Enrollment Application
A NYS Medicaid Enrollment Application must be submitted by a prospective provider. The completed application will be reviewed by NYS Department of Health. The determination will be sent to the provider, in writing, upon approval or denial of the application. If more information is necessary to process the application, the provider will be notified as to what information is needed and where to send it. If the application is approved, the provider will be notified of his/her provider ID Number and the effective date when services may be provided to an enrolled client.
Effective August 23, 2013 a completed Certification Statement and an Electronic Funds Transfer (EFT) Authorization Form must be submitted with the Enrollment Application for all billing providers.
Step 3 (Required) - Provider Manuals
Before rendering service to a client, providers need to become familiar with the policies and procedures of the Medicaid Program which are located on the emedny.org website.
Step 4 (Required) - Client Eligibility Verification
Providers must verify the eligibility of the client via the Medicaid Eligibility Verification System (MEVS) before rendering service. The MEVS manual located on the emedny.org website and considered part of the provider manual, gives detailed instructions for the available methods for verifying eligibility and the meaning of messages returned by MEVS. MEVS will verify eligibility for any current or past date and give information about clients who are enrolled in Medicaid Managed Care plans or who have Medicare or other insurance coverage. If other coverage exists for the client, the provider will need to bill the other insurance first as Medicaid is the Payer of Last Resort.
Step 5 (Optional) - Prior Approval
Certain services require prior approval (PA) by the appropriate NY State or county office before a claim can be submitted. Please review the provider manual specific to your provider type to obtain information regarding PA requirements. If PA is required, there are various methods for submitting a PA request. Paper PA forms are available to enrolled providers by calling 1-800-343-9000. Electronic PA requests may also be submitted via ePACES (see below – Step 8).
Step 6 (Required) - Claims Submission
Providers are given several options for submitting claims to the NYS Medicaid Program. Most providers today submit claims electronically. In fact, approximately 97% of claims submitted to the Medicaid Program are sent in an electronic format. Electronic claim transactions that are currently processed by eMedNY are the 837 Professional (837P), the 837 Institutional (837I), the 837 Dental (837D) and NCPDP (pharmacy claims). Details for electronic claim submissions are below:
Enrollment in ePACES requires a Medicaid Provider ID number and an internet address. To start the ePACES enrollment process contact the eMedNY Call Center at 1-800-343-9000. Please note that while a provider can sign up for ePACES without an ETIN, an ETIN is required before claims can be submitted via ePACES.
ePACES supports the following types of transactions:
Step 7 (Optional) - Remittance Options
The processing of most Medicaid transactions is performed by Computer Sciences Corporation (CSC). CSC is the eMedNY contractor for the NYS Medicaid Program. eMedNY processes transactions 24 hours a day, 7 days a week and issues checks and remittance statements weekly, for processed claims. Medicaid checks and paper remittances are held for two weeks and two days before issuing to the provider.
Electronic remittances are issued in a HIPAA-compliant format known as the 835 or 820; therefore software is required to interpret the remittance information.
PDF Paper Remittances
There are many advantages to receiving a PDF version of the paper remittance:
In order to receive the New York Medicaid paper remittance advice in a PDF format through eMedNY eXchange, click here.
Thank you for your interest in enrolling in the New York State Medicaid Program.