Please see Training Page for seminar classes scheduled for 5010. Note: these are on the link to 5010 document at the top of the page. Regular classes (non-5010) appear in both the regular spreadsheet and the drop-downs:

• Training Page

The Pharmacy Policy Section has been updated as follows. The policy on Smoking Cessation (page 24) and Plan B on (page 25) has been updated. The information on page 12, Pharmacists as Immunizers, is new policy added to the manual. Please see:

• Pharmacy Policy Guidelines

New Provider Communications:

• DME

The following Provider Maintenance forms were updated. Note – The Affiliation/Disaffiliation Request Form replaces the Provider Participation in a Group Form:

• Affiliation/Disaffiliation Request
• Fee for Service Address Change
• Prescription Footwear Form
• Specialty Certification

The following Maintenance Forms have been modified to be typeable. This enhancement will alleviate problems related to legibility of the information entered on the forms. See instructions at the top of the Maintenance Forms page:

• Office Based Surgery
• DEA Update Form
• Medicare Info Update Form
• Tax Update Form
• Clinic Certification of Staff Certified as Asthma Educators
• Clinic Certification of Staff Certified as Diabetes Educators
• Electronic Prior Approval Request Form
• Request to Enroll New NPI Form

The Physician Billing Guideline has been updated with new instructions for Anesthesiology Services and new 150003 claim form exhibits:

• Physician

The following Maintenance Forms have been modified to be typeable. This enhancement will alleviate problems related to legibility of the information entered on the forms. See instructions at the top of the Maintenance Forms page:

• Electronic Remittance Request Form
• Fee for Service Address Change Form
• Out of State Hospital Enrollment Package Request Form
• Prior Conduct Questionnaire Form
• Provider Participation in a Group Form
• Rate Based Change of Address Form

The following procedure codes have been added to Physician:

• Physician Anesthesia Procedure Codes

The Transportation Policy Section has been updated to include procedures to be followed for entities which provide advanced life support-first responder ambulance services:

• Transportation Policy Guidelines

The following 2010 Fee Schedule has been updated:

• Physician Anesthesia 2010 Fee Schedule

New Provider Communication:

• Physician

New Provider Communications:

• Midwife
• Nurse Practitioner
• Physician

A link to the List of Participating Drug Companies (Medicaid Drug Rebate Program) has been added to the Provider Manual web pages for the following provider types:

• Dental
• Midwife
• Nurse Practitioner
• Ordered Ambulatory
• Physician
• Podiatry

New Provider Communication:

• Dental

New Provider Communication:

• Pharmacy

The Medicaid Vision Care policy manual has been updated to reflect current policy:

• Vision Care Policy Guidelines

The following 2010 Fee Schedule has been updated:

• Physician Drugs 2010 Fee Schedule

A link to the Medicaid List of Reimbursable Drugs (Formulary File) has been added to the Provider Manual web pages for the following provider types:

• Physician
• Nurse Practitioner
• Midwife
• Ordered Ambulatory
• Clinic
• Podiatry
• Dental

New Provider Communication:

• Pharmacy

New Provider Communication:

• Private Duty Nursing

New Provider Communications:

• Dental
• DME
• Midwife
• Nurse Practitioner
• Pharmacy
• Physician

New Provider Communication:

• Dental
• Midwife
• Nurse Practitioner
• Physician

The following Billing Guideline was updated:

• Physician

Modifications have been made to the following:

• ProDUR-ECCA Provider Manual
• ProDUR-ECCA Standards Manual

The Transportation Prior Authorization Guidelines Manual has been updated to reflect a revised transportation office telephone number and changes to ADHC ambulette transportation. Please See:

• Transportation Prior Authorization Guidelines Manual

New Provider Communications:

• Transportation

Format has been enhanced and Remittance Advice samples have been updated in the following Billing Guidelines:

• Chiropractor
• Clinical Psychology
• Clinical Social Worker
• DME
• Hearing Aid
• Hospital Ordered Ambulatory
• Laboratory
• Midwife
• Nurse Practitioner
• Private Duty Nursing
• Physician
• Podiatry
• Rehabilitation Services
• Vision Care

The following Provider Maintenance form has been added:

• Office Based Surgery

The following Provider Maintenance forms were updated:

• Change of Category and / or Address Form
• Fee for Service Address Change
• Prescription Footwear Form
• Specialty Certification

Modifications have been made to the following:

• ProDUR-ECCA Provider Manual
• ProDUR-ECCA Standards Manual

The following MEVS guides were updated:

• MEVS Telephone Quick Reference Guide
• MEVS VeriFone Omni 3750/Vx570 Quick
  Reference Guide

All Medicaid Provider Enrollment forms have been updated to include information on the Provider Compliance Program requirements found in Title 18NYCRR, Part 521.  To determine whether the Provider Compliance Program affects you, please visit the website of the Office of the Medicaid Inspector General at http://www.omig.ny.gov/data/content/view/81/206/

The following Provider Enrollment Packets were updated:

• Certified Asthma Educator
• Certified Diabetes Educator
• Chiropractor
• Clinical Psychologist
• Clinical Social Worker
• Dentist
• DME
• Group
• Hearing Aid
• Laboratory
• Laboratory Director
• LPN/RN
• Midwife
• Nurse Practitioner
• Nurse Registry
• Optical Establishment / Salaried Optician / Optometrist
• Optician / Optometrist / (Self Employed)
• Pharmacy
• Physician
• Physician’s Assistant (Registered)
• Podiatrist
• Portable X-Ray
• Salaried Optician-Salaried Optometrist
• Service Bureau (Billing Agency)
• Supervising Pharmacist
• Therapist (PT/OT/Speech)
• Transportation

Additionally, all Rate Based / Institutional Form Instruction Pages were changed in accordance with the above regulations. Please see these forms located on the bottom of:

• http://www.emedny.org/info/ProviderEnrollment
  /index.aspx

The training session search has been improved, including a new clickable map. Please see:

• Training for Providers

New Physical and Occupational Therapy Services (PT/OT) Policy Guidelines:

• Rehabilitation Services Manual Policy Guidelines

Information for All Providers – Managed Care has been updated. Elderplan M/M MMIS # 03186129, a new Ma Advantage plan has been added to the SOB effective 6/1/2010. Please see:

• Information for All Providers – Managed Care

The following Provider Maintenance forms were updated:

• Default Electronic Transmitter Identification Number (ETIN) Selection Form
• Electronic Prior Approval Request Form
• Electronic Remittance Request Form
• Paper Remittance Sort Request Form
• Pended Claim Recycle Request Form
• Request to Disaffiliate/Delete an ETIN

Information for All Providers – General Policy has been updated: Page 6 – Date and time stamp helps identify the most current Common Benefit Identification Card (CBIC). Please see:

• Information for All Providers - General Policy

New Provider Communications:

• Vision Care

The Transportation Contact List contains a revised telephone number for Putnam County. Please see:

• Transportation Contact List

The following Provider Maintenance form was updated:

• Request to Disaffiliate/Delete an ETIN

In response to regulatory and operational changes, the Out of State Prior Approval Policy for Inpatient has changed. Please see:

• Out-of-State Hospital Prior Approval Guidelines

New Provider Communication:

• Inpatient

Modifications have been made to the following:

• Posting Provider List

The following Provider Maintenance forms were updated:

• EFT-PDF Paper Remittance Request Form
• Electronic Remittance Request Form

New Provider Communication:

• Dental

The following Provider Maintenance form was updated:

• Provider ID Request Form (Fee for Service Only)

The following Policy Guidelines Manual has been updated:

• Private Duty Nursing Policy Guidelines

The following 2010 Fee Schedules and Procedure Codes sections have been updated:

• Clinical Psychology 2010 Fee Schedule and Procedure Codes
• Dental 2010 Fee Schedule
• Dental 2010 Procedure Codes
• DME 2010 Fee Schedule
• DME 2010 Procedure Codes
• Midwife 2010 Fee Schedule
• Midwife 2010 Procedure Codes
• Nurse Practitioner 2010 Fee Schedule
• Nurse Practitioner 2010 Procedure Codes
• Nurse Practitioner Enhanced Program 2010 Fee Schedule
• Ordered Ambulatory 2010 Fee Schedule
• Ordered Ambulatory 2010 Procedure Codes
• Pharmacy 2010 Fee Schedule
• Pharmacy 2010 Procedure Codes
• Physician Drugs 2010 Fee Schedule
• Physician Enhanced Program 2010 Fee Schedule
• Physician Medicine 2010 Fee Schedule
• Physician Radiology 2010 Fee Schedule
• Physician Surgery 2010 Fee Schedule
• Physician Medicine and Drugs 2010 Procedure Codes
• Physician Radiology 2010 Procedure Codes
• Physician Surgery 2010 Procedure Codes
• Podiatry 2010 Fee Schedule
• Podiatry 2010 Procedure Codes
• Private Duty Nursing 2010 Procedure Codes
• Vision Care 2010 Fee Schedule
• Vision Care 2010 Procedure Codes

The Transportation Contact List contains updated contact information for Herkimer County. Please see:

• Transportation Contact List

New Provider Communication:

• Dental

Information for All Providers – Managed Care Information has been added. Please see:

• Information for All Providers – Managed Care Information

New Provider Communication:

• Dental

The Formulary File will now be updated daily.

Please see the following UT (Utilization Threshold) Program Update (located in the Notifications Section) for information regarding two important changes in the UT program:

• Utilization Threshold (UT) Update

Please review important NPI information in the following guideline:

• Utilization Threshold Program

The Transportation Contact List has been updated. Please see:

• Transportation Contact List

Modifications have been made to the following:

• ProDUR-ECCA Provider Manual
• ProDUR-ECCA Standards Manual

The following Provider Maintenance form was added:

• Request to Enroll New NPI Form

Modifications have been made to the following:

• MEVS Provider Manual
• Quick Reference Cards VeriFone Omni 3750
• Quick Reference Cards ARU

New Provider Communication:

• Free Standing or Hospital Based Ordered Ambulatory
• Physician

The following Provider Enrollment Packets were updated:

• Dentist
• DME
• Group
• Hearing Aid
• Laboratory
• Laboratory Director
• LPN/RN
• Medicaid Obstetrical and Maternal Services (MOMS) Program (Midwife, Nurse Practitioner, Physician)
• Medically Fragile Children PDN Rate Enhancement
• Nurse Registry
• Optical Establishment / Salaried Optician / Optometrist
• Optician / Optometrist / (Self Employed)
• Pharmacy
• Portable X-Ray
• Service Bureau (Billing Agency)
• Supervising Pharmacist
• Transportation

The following Provider Maintenance forms were updated:

• Fee for Service Address Change
• Supervising Pharmacist Agreement