Ny Medicaid Provider Enrollment Form For Groups


Options For The Delivery Of Ipsidd

9.29.17 Medicaid Provider Enrollment Webinar

Clinicians working as independent practitioners enrolled in Medicaid will receive direct payment from Medicaid for services rendered.

Clinicians who are employees, members or affiliates of a group practice that is enrolled in Medicaid will no receive direct payment. The group practice will submit and receive payment for services rendered.

Learn Medicaid Billing Policies And Procedures

Before rendering service to a client, providers need to become familiar with the policies and procedures of the Medicaid Program.

  • Begin with Information for All Providers:
  • Select the Provider Manual for your type from the Provider Manuals Page. Each manual contains :
  • Policy Documents
  • Institutional or Practititioner Billing Guidelines
  • Provider-specific Billing Guidelines

Determine How You Will Submit Claims To Emedny

Providers are given several options for submitting claims to eMedNY

Option 1: HIPAA Compliant Claim Formats Submitted Directly to eMedNY

Option 2: Medicaid’s Electronic Provider Assisted Claim Entry System web-based application

  • Claims: Professional Institutional and Dental
  • Claim Status Requests**
  • Prior Approval Requests
  • Eligibility Verification

*Real-time means that the claims are processed instantaneously and the provider can view the status of a real-time claim within seconds. There is no need to wait for a remittance statement to be mailed to find out about the status of submitted claims. **The status of claims submitted via the ePACES batch feature is generally available within 24 hours. To enroll in ePACES:

Option 3 Paper Claim Forms

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Where Do I Send My Completed Forms

Medicaid Provider Enrollment Application Instructions

Send Your Application by Email

Please send your completed application and agreement to: .

All applications for the PPO Dental Networks should follow the process found on the Join Our Dental Networks page, send your completed application and agreement to: .

Please note: The email addresses above are for the submission of new applications only. Status requests may be made to Provider Services at 866-447-9717. Please wait at least 45 days before inquiring on status.

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Notification Of Determination By Nys Doh

A written determination of approval or denial of the submitted application will be sent to the provider.

If the application is approved, a letter containing the provider’s MMIS ID Number, the effective date when services may be provided to an enrolled client, and other information related to their enrollment will be sent to the enrollee.

How Do I Apply For Medicaid

You can apply for Medicaid in any one of the following ways:

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Apply To Humanas Behavioral Health Network

Humana actively recruits:

  • Nurse practitioners certified in behavioral health or psychiatry
  • Psychologists
  • Licensed marriage and family therapists
  • Behavioral health professionals who are licensed independently in the state where they practice.

We also are seeking individuals who hold a Certified Employee Assistance Professional certification in conjunction with the required state license.

If you would like to join Humanas behavioral health network, please email us at .

Healthcare Legal Alert: Expedited Medicaid Provider Enrollment Options In Response To Coronavirus Public Health Emergency

NYS Medicaid Home Care Changes Coming in 2022

On April 20, 2020, the New York State Department of Healths Bureau of Medicaid Provider Enrollment announced that expedited enrollment options including online enrollment are now available for temporarily enrolling providers who are responding to the coronavirus public health emergency. In addition to the expedited enrollment process, New York Medicaid is waiving application fees and the site visit and fingerprint-based criminal background check screening requirements for these applicants.

There are, however, limitations as to which providers may use the new expedited Provisional Temporary Provider Enrollment application process and the duration of such enrollment status.

Expedited enrollment is available only for nurses , nurse practitioners, physicians and registered physician assistants who are not currently enrolled in New York Medicaid and who do not have a New York Medicaid enrollment application pending. Also, to be eligible, a provider must be enrolled in Medicare or another states Medicaid program or, alternatively, must not be currently excluded from New York State Medicaid, cannot appear on the Office of Inspector General Exclusions Database, and must be licensed and legally authorized in at least one state or United States territory to practice or deliver the service for which they file professional services claims.

The PTPE application requires the following data elements:

Expedited Submission of PTPE Applications

Option 1 Online Form:

Option 2 Email:

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How To Become A Medicaid Provider

Providers delivering autism spectrum disorder services must be enrolled with SCDHHS as a Medicaid provider to deliver and bill for Medicaid state plan benefit ASD services.

To enroll with SCDHHS as a Medicaid provider:

  • Prep for Enrollment: Providers will need a national provider identification and taxonomy number. Apply for individual National Provider Identifier number. Use the correct taxonomy code as listed in the provider manual.
  • Complete and submit the Medicaid provider enrollment application.
  • SCDHHS will notify providers of successful enrollment.
  • *Note, BCBA and BCaBA providers must enroll individually. If there is a group practice, a group enrollment must also be completed.

    To enroll with one of the managed care organizations , a provider must be an approved Medicaid provider. Providers need to contact the MCO directly to complete the network enrollment process. Providers are not required to enroll with a MCO, but they may not be reimbursed by the MCO for services provided to beneficiaries enrolled in managed care.

    To enroll with a MCO:

    • Contact each MCO to begin the process of contracting, credentialing and enrolling.
    • MCO contact information:

      Healthy Blue 757-8286

      First Choice by Select Health 741-6605

      Molina Health Care of South Carolina 237-6178

    P. O. Box 8206 Columbia, SC 29202-8206 | Email: | phone: 549-0820

    Language Services

    If your primary language is not English, language assistance services are available to you, free of charge. Call: 1-888-549-0820 .

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    How To Apply For Ny Medicaid

    New York State Medicaid Form

    You may apply for Medicaid in the following ways:

    Where you apply for Medicaid will depend on your category of eligibility, which might be single, childless couples, pregnant women, parent and caretaker relatives with dependent children, elderly, and/or disabled. Certain applicants may apply through NY State of Health while others may need to apply through their Local Department of Social Service . For more information on determining where you should apply read on

    The Marketplace determines eligibility using Modified Adjusted Gross Income Rules. In general, income is counted with the same rules as the Internal Revenue Service with minor variations. Applications may be completed online, with an Enrollment Assistor, by mail, or by phone.

    The following individuals should apply through the Marketplace :

    • Adults 19-64 years of age and not eligible for Medicare,
    • Pregnant Women and Infants,
    • Children 1 – 18 years of age, and
    • Parents and Caretaker Relatives.

    The following individuals should apply with their Local Department of Social Services :

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    Who Will Conduct My Credentialing

    EmblemHealth partners with various organizations to give our members the benefit of value-based care, administrative efficiencies, and specialized expertise. Where appropriate, EmblemHealth has entered into agreements with these partners to perform credentialing on EmblemHealths behalf. EmblemHealth has a stringent oversight process to ensure these partners meet our high standards. In certain circumstances, health care professionals are required to sign direct agreements with these partners and go through their credentialing processes.

    Depending on your specialty or practice affiliation, you may need to apply for participation through one of EmblemHealths partners.

    Expand the following two tabs to see if your specialty or practice has a separate process in place that you will need to follow.

    Based on your specialty, click on the link below to get more information about credentialing. If your specialty is not listed, download and complete the EmblemHealth credentialing documents under Before You Apply.

    There are exceptions to the partnerships listed below. Please contact your Administrator regarding participation with EmblemHealth if you are part of:

    • HealthCare Partners
    • A federally qualified health center
    • A diagnostic and treatment center

    Locations Ipsidd Services Can Be Delivered

    IPSIDD services can be delivered in the following locations:

    • IRAs, CRs or Family Care homes certified by OPWDD, or private residences
    • Certified day habilitation, pre-vocational and day training facilities
    • Community settings as deemed appropriate by the clinician, including community settings where OPWDD services may occur, or
    • Clinicians private offices
    • Clinic treatment facilities certified by OPWDD, DOH, OMH, and OASAS
    • Hospitals
    • Other licensed or certified residential or day healthcare settings that include the clinical services of OT, PT, SLP, psychology, or social work as part of its service model and reimbursement rates

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    What Do I Need To Apply

    The necessary documentation needed to apply for Medicaid also depends on your category, specifically whether you fall under the Modified Adjusted Gross Income or non-MAGI guidelines. These guidelines are defined in the section below.

    MAGI eligibility groups include:

    • Pregnant women
    • Infants and children under 19 years of age
    • Childless adults who are not pregnant, 19-64 years of age, not on Medicare, and could be certified disabled but not on Medicare
    • Parents/caretaker relatives
    • Family Planning Benefit Program and/or
    • Children in foster care

    Non – MAGI Eligibility Groups include:

    • Individuals 65 years of age or older, who are not a parent or caretaker relative,
    • individuals who are blind or disabled who do not meet the criteria of any of the MAGI eligibility groups
    • Residents of Adult Home run by LDSS, OMH Residential Care Centers/Community Residences
    • Individuals eligible for the following programs:
      • COBRA
      • AIDS Health Insurance Program
      • Medicaid Buy-in Program for Working People with Disabilities
      • Medicaid Cancer Treatment Program

    Application for Non-MAGI

    The following paper application may only be printed and completed if you are applying at an LDSS for Medicaid because you are over 65 years of age or an individual in your household is deemed certified blind or disabled, or you are applying for Medicaid with a spenddown.

    English, Spanish, Chinese, Haitian Creole, Italian, Korean, Russian

    Doh Posts Faqs On Medicaid Enrollment Requirement

    New Provider/New Biller — Medicaid Partners

    The Department of Health has posted Frequently Asked Questions regarding the requirement that health care providers who contract with managed care plans enroll in Medicaid and obtain a Medicaid provider number. This applies to Licensed Home Care Services Agencies , even though they dont bill Medicaid directly. To view the recent FAQs posted by DOH, click here.

    As a reminder, the 21st Century Cures Act requires all Medicaid Managed Care providers to be enrolled with State Medicaid programs no later than Jan. 1, 2018. Providers can still enroll if they havent already. If you received a letter from your Managed Care Organization stating that you have been identified as a provider who is not actively enrolled with the New York State Medicaid program and are providing services to their Medicaid-eligible members, you must enroll, or you will be removed from their MMC provider network. The Medicaid provider enrollment process is to ensure appropriate and consistent screening of providers and improve program integrity.

    To enroll, you will need to go to the Provider Index on the eMedNY website and navigate to your provider type to print and review the instructions and enrollment form. Here, you will also find a Provider Enrollment Guide and How Do I Do It? resource guide. Click here for Useful Links, which include FAQs and additional information related to the MMC network provider enrollment in New York State Medicaid.

    Contact: Meg Carr Everett, , 518-867-8871

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    Differences Between Billing And Payment Of Ipsidd And Article 16 Clinics

    • IPSIDD claims will have no rate codes.
    • IPSIDD will not be processed through the 3M APG grouper-pricer.
    • No APG Base Rates and SIWs
    • No APG discounting
  • IPSIDD claims will be priced based on the following factors:
  • CPT code describing the services rendered
  • Special IPSIDD regional fee assigned to the CPT code by MH Rate Setting
  • Where applicable, the CPT unit quantity
  • Service claims will be submitted to Medicaid under the personal NPI of the rendering/ supervising licensed clinician. However, payment may be reassigned to a group practice by inserting the group practices NPI in the Pay to Provider field of the claim.
  • All rendering/supervising clinicians must be enrolled providers of the NYS Medicaid program.
  • Submit An Enrollment Application For Your Provider Type

    A NYS Medicaid Enrollment Application must be submitted by prospective providers. Go to the Provider Index page on this site. Each Provider enrollment form has:

    • a separate instructions document for field-specific instructions, additional forms and/or documentation
    • The enrollment form to be submitted
    • Links to all additional forms that may be submitted based on provider type

    Applications that are missing one or more requirements will be sent back to the enrollee for completion.

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    Setting Up Remittance Advice Receipt And Payment Options

    The processing of most Medicaid transactions is performed by the eMedNY fiscal agent 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.

    Remittance Advices are generated every week for claims submitted from Thursday to Wednesday prior, and are available in multiple formats.

    • Electronic 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 Remittance AdvicePDF version of the paper remittance is viewed with Adobe Reader® which is available free of charge. This Remittance Advice format may be downloaded and stored electronically. Additionally, it is not held with any corresponding paper Medicaid check for two weeks but released to you two weeks earlier. In order to receive the New York Medicaid paper remittance advice in a PDF format through eMedNY eXchange,
    • Paper Medicaid checks and paper remittances are held for two weeks and two days before being issued to the provider.

    ENQUIRIES: Questions should be directed to the eMedNY Call Center at 1-800-343-9000. Before submitting claims, providers may also phone the Call Center to request training from a eMedNY Regional Representative.

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    Other Limitations Or Restrictions

    • IPSIDD cannot be provided to people receiving or eligible to receive similar clinical services from the Early Intervention Program.
    • IPSIDD must not duplicate or replace Preschool Supportive Health services or School Supportive Health services that are authorized through an approved IEP. However, IPSIDD may address service needs of preschool and school-aged children that are not addressed in the IEP and are not school-related as determined by the childs Committee on Special Education.
    • IPSIDD services must not duplicate or replace services available through the ICF/IID program, or OPWDD operated or certified residential or day programs.
    • IPSIDD services must not duplicate OPWDD funded HCBS services, including Intensive Behavioral Services or services provided in-clinic treatment facilities and hospital outpatient departments or services provided by Certified Home Health Agencies. However, services described by the same clinical procedure code may be provided to address different clinical needs.
    • Time spent receiving another Medicaid service cannot be counted toward IPSIDD billable service time in instances when the Medicaid service is received at the same time as IPSIDD services 13.


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