Medicaid - Guidance Documents
ADM and GIS Messages
Clinic
Durable Medical Equipment (DME)
- Basis of Payment for Durable Medical Equipment for Managed Care
- Changes to the Dispensing Validation System
- Changes to DME Fee Schedules
- Changes to Pharmacy Fee Schedules
- Coding Changes for Pharmacy Providers
- Coding Changes for DME Providers
- Dispensing Validation System (DVS) Cancellations
- DME Fee Schedule Change
- DME Provided to Assisted Living Program Participants
- DME Providers Corrections to 11/00 Policy Section Revision
- Durable Medical Equipment Prior Approval Requests
- Emergency Procedures for Durable Medical Equipment
- Enteral Formula Reimbursement Change
- Enteral Products List Guideline
- Fee Schedule Changes for Prosthetics
- Fee Schedule Changes for Durable Medical Equipment
- Guidelines for Delivery of Prescription Drugs, OTC Products, M/S Supplies and DME November 2003
- Important Pharmacy & DME Contact Numbers
- Medical-Surgical Supplies... When to Refill? September 2003
- New Payment for Power Mobility Device Evaluation Services
- Personal Hygiene Products are not Medical-Surgical Supplies
- Payment for Durable Medical Equipment in Facilities
- Pharmacies, DME Suppliers & Orderers - Enteral Billing
- Prior Approval Reviews for Clients Residing in Western NY
- Prior Approval Process for Enrollees Eligible for Both Medicare & Medicaid
- The Ventilator Rental Fee has Changed
- Transportation & DME Providers Enrollment Requirements for Each Operating Location
Durable Medical Equipment (DME) Provider Communications
- 2007 DME Procedure Code Changes (PDF, 12.09KB, 1pg)
- 2007 Supply Procedure Code Change (PDF, 8.04KB, 1pg.)
- 2007 Orthotics & Prosthetics Procedure Code Change (PDF, 15.82KB, 2pg)
- DME Code Changes-January 1, 2006 (PDF, 25.17KB, 1pg.)
- DME Provider Letter (PDF, 92.76KB, 3pg)
- DME Provider Letter (Fee Schedule Revision) (PDF, 102.45KB, 2pg)
- DME Provider Letter (Providers and Orderers) (PDF, 57.02KB, 4pg.)
- Durable Medical Equipment Updates (PDF, 18.16KB, 1pg.)
- DVS Authorization for Manual Wheelchairs & Certain Wheelchair Accessories (PDF, 11.52KB, 1pg)
- Enteral Formula Dispenser Worksheet (PDF, 20.39KB, 1pg.)
- Enteral Product Classification List (PDF, 42.73KB, 7pg)
- Fee Changes for Wheelchair Cushions & Battery Charger (PDF, 17.52KB, 1pg.)
- Footwear 1-1-2006 Changes-Updated (PDF, 31.72KB, 1pg.)
- Footwear Code Changes-January 1, 2006 (PDF, 20.78KB, 1pg)
- Orthotics & Prosthetics Code Changes - January 1, 2006 (PDF, 36.92KB, 1pg.)
- Prior Approval for Dually Eligible (PDF, 67.27KB, 3pg.)
- Revisions to Wheeled Mobility Equipment Guidelines (PDF, 9.71KB, 1pg.)
- Silhouette Seat Cushion & Back (PDF, 23.33KB, 1pg.)
- Two New Processes Affecting DME Providers Effective January 23, 2006 (PDF, 212.99KB, 4pg)
- Wheeled Mobility Evaluation Template (MS Word Format)
- Wheeled Mobility Equipment Guidelines (PDF, 67.27KB, 3pg)
- Wheeled Mobility Seating & Positioning Guidelines (PDF, 74.63KB, 21pg.)
eMedNY
- Manuals - For All Specialties
- Fee for Service Enrollment Form
- Deceased Provider List
- Disqualified Provider List
- Fee for Service Maintenance Forms
- Foster Family Care
- HCBS/TBI Waiver Services - Provider Manual
- Home Health Services - Provider Manual
- Hospice - Provider Manual
- Letters and Notifications to Providers
- Long Term Health Care - Provider Manual
- Medicaid Update
- National Provider Identifier (NPI) Registry
- Online License Verification
Enteral
- Enteral Formula Reimbursement Change
- Enteral Therapy
- Enteral Therapy: Calculation of Caloric Units
- Frequently Asked Questions - Medicaid Coverage of Oral Enteral Formulas
- Helpful Hints for the Enteral Voice Interactive Telephone Prior Authorization System
- Important Prior Authorization Pharmacy Phone Numbers
- Is Your Patient Covered by Medicare?
- Reimbursement & Coding Changes for Enteral Formula
Family Planning Benefit
Medicaid Reference Guide (MRG)
- Medicaid Reference Guide
- Categorical Factors (PDF, 20.35KB, 9pg.)
- Income (PDF, 1.67MB, 214pg.)
- Resources (PDF, 23.27KB, 11pg.)
- Other Eligibility Requirements (PDF, 1.32MB, 172pg.)
Medicaid Update
- Are You Receiving Medicaid Correspondence at the Appropriate Address?
- Attention Dental and Dental Clinic Providers - Edit 868 Process Revised and Streamlined
- Attention: Hospital & Clinic Employed Physicians Enrollment in the Medicaid Program
- Attention : Laboratories, Physicians, & Other Ordering Providers (Triple Test)
- Attention Pharmacy Providers - Edit 867 Process Revised and Streamlined
- Attention Teaching Physicians Who Supervise Residents
- Basis Of Payment For Durable Medical Equipment For Managed Care Recipients
- Claims Pending for Edits 01154 & 01155
- Comprehensive Case Management: Payment Guidelines
- Conditions For Ordering Enteral Nutrition
- Delivery of Prescription Drugs, OTC Products, Medical/Surgical Supplies & DME
- DME Providers Corrections to 11/00 Policy Section Revision
- Enrollment & Coverage for Newborns
- Enteral Formula: Change In Reimbursement
- Enteral Formula Prior Authorization Program
- Enteral Products Classification List
- Fee-for-Service Enrollment and Maintenance Form Packets Will Soon Change
- Highlights of Changes in The Medicaid Program
- Laboratories Billing Molecular Diagnostic Procedure Codes
- Laboratory Payment for HIV Test
- Lawsuit Decision-Provider Assistance Needed: Aliessa/Adamolekum et. al. vs Novella
- Maximum Quantity Edits
- Medicaid Fee-for-Service Enrollment Forms Have Changed!
- Medicaid Info for Providers
- Medicaid Payment to Laboratories for Hepatitis C Tests
- Medicaid Prescription Requirements
- National Provider Identifier (NPI) Implementation
- New Coverage Codes Announced Resource Attestation to be Implemented July 2004
- New Coverage Codes Reminder Resource Attestation to be Implemented August 2004
- New Edits For Part Time Clinics
- New Payment Edit for OMRDD Home & Community Based Services (HCBS) Waiver Claims
- Office & Physician Specialty Fee Increases Effective October 1, 2000
- Ordering and Providing Supplies: Frequency and Quantity Limits
- Payment For Durable Medical Equipment in Facilities
- Payment of Nursing Home Claims - Guidelines To Follow For Accurate Billing
- Payments for Referred Lab Testing
- Pharmacists: New Nursing Home Eligibility Edits & Messaging
- Physician Fee Increases
- Prescribers & Pharmacy Providers Medicaid Prescription Requirements Reminder
- Presumptive Eligibility for Pregnant Women
- Provider Enrollment Forms Now Include NPI
- Reimbursement and Coding Changes for Enteral Formula
- Reimbursement to Nurse Practitioners and Midwives for Practitioner Office Laboratory
- Required Medical Record Documentation for Supervising/Teaching Physicians
- Revisions to Medicaid Laboratory Regulations (Title 18 NYCRR Section 505.7)
- Separate Provider Identification Number Required for Each Dispatching Operating Location
- Timely Submission of Claims to Medicaid
- Use of Electronic Records by Medicaid Providers
- Viagra Edit Change
New York Partnership for Long Term Care
- Consumer Participation Agreement (PDF, 100.08KB, 10pg.)
- Insurer Participation Agreement (PDF, 421.01KB, 38pg.)
Office of Alcoholism & Substance Abuse Services (OASAS)
- Managed Care Changes for Alcohol & Substance Abuse Services
- Outpatient Chemical Dependence Services Dec 2002
Office of Mental Health
- Mental Health Providers Servicing Managed Care Recipients
- Payment for Psychiatric Social Services Work Services in FQHC's
NYS Office of Mental Retardation and Developmental Disabilities (OMRDD)
- Medicaid Payment for Psychiatric Social Work Services in FQHC's
- Residential & Day Programs Now Responsible for Personal Care/HHA's Services
Ownership
- All Providers (Fee for Service & Rate Based) Must Disclose Ownership & Control April 2002
- All Providers (Rate Based Institutional) Must Disclose Ownership & Control September 2006
Provider
- Manuals - For All Specialties
- Are You Receiving Medicaid Correspondence at the Appropriate Address?
- Important Prior Authorization Pharmacy Phone Numbers
- Is Your Patient Covered by Medicare?
- Medicaid Fee-for-Service Enrollment Forms Have Changed!
- National Provider Identifier (NPI) Implementation
- Provider Enrollment Forms Now Include NPI
Provider Billing and Policy
- Assisted Living Billing Guidelines (PDF, 183.85KB, 52pg.)
- Assisted Living Policy Guidelines (PDF, 115.40KB, 11pg.)
- Child Care Billing Guidelines (PDF, 161.48KB, 47pg.)
- Child Care Policy Guidelines (PDF, 273.42KB, 28pg.)
- Chiropractor Billing Guidelines (PDF, 414.89KB, 61pg.)
- Chiropractor Policy Guidelines (PDF, 53.10KB, 9pg.)
- Clinic Billing Guidelines (PDF, 190.81KB. 44pg.)
- Clinic Policy Guidelines (PDF, 556.62KB, 43pg.)
- Clinical Social Worker Billing Guidelines (PDF, 977.05KB, 60pg.)
- Clinical Social Worker Policy Guidelines
- Clinical Psychology Billing Guidelines (PDF, 414.63KB, 60pg.)
- Clinical Psychology Policy Guidelines (PDF, 67KB, 9pg.)
- Comprehensive Medicaid Case Management (CMCM) Billing Guidelines (PDF, 175.41KB, 52pg.)
- Comprehensive Medicaid Case Management (CMCM) Policy Guidelines (PDF, 162.44KB, 31pg.)
- Day Treatment Billing Guidelines (PDF, 174.17KB, 51pg.)
- Day Treatment Policy Guidelines
- Dental Billing Guidelines (PDF, 418.79KB, 65pg.)
- Dental Policy Guidelines (PDF, 85.87KB, 16pg.)
- DME Billing Guidelines (PDF, 690.50KB, 62pg.)
- DME Policy Guidelines (PDF, 227.96KB, 28pg.)
- Free Standing or Hospital Based Ordered Ambulatory Manual Billing Guidelines (PDF, 462.07KB, 72pg.)
- Free Standing or Hospital Based Ordered Ambulatory Manual Policy Guidelines (PDF, 11.55KB, 2pg.)
- HCBS/TBI Waiver Services Manual Billing Guidelines (PDF, 168.89KB, 49pg.)
- HCBS/TBI Waiver Services Manual Policy Guidelines (PDF, 47.04K, 8pg.)
- Hearing Aid Billing Guidelines (PDF, 263.31KB, 40pg.)
- Hearing Aid Policy Guidelines (PDF, 117.30KB, 19pg.)
- Home & Community Based Services (HCBS) Waiver Billing Guidelines (PDF, 163.01KB, 49pg.)
- Home & Community Based Services (HCBS) Waiver Policy Guidelines (PDF, 72.80KB, 10pg.)
- Home Health Billing Guidelines (PDF, 180.13KB, 52pg.)
- Home Health Policy Guidelines (PDF, 55.61KB, 14pg.)
- Hospice Billing Guidelines (PDF, 180.74KB, 53pg.)
- Hospice Policy Guidelines
- ICF-DD Billing Guidelines (PDF, 174.17KB, 54pg.)
- ICF-DD Policy Guidelines
- Inpatient Billing Guidelines (PDF, 410.89KB, 70pg.)
- Inpatient Policy Guidelines (PDF, 195.41KB, 27pg.)
- Laboratory Billing Guidelines (PDF, 972.95KB, 60pg.)
- Laboratory Policy Guidelines (PDF, 118.31KB, 25pg.)
- Limited Licensed Home Care Services Agency (LLHCSA) Billing Guidelines (PDF, 169.67KB, 50pg.)
- Limited Licensed Home Care Services Agency (LLHCSA) Policy Guidelines (PDF, 44.77KB, 2pg.)
- Long Term Home Health Care Program (LTHHCP) Billing Guidelines (PDF, 180.25KB, 52pg.)
- Long Term Home Health Care Program (LTHHCP) Policy Guidelines (PDF, 44.77KB, 2pg.)
- Midwife Billing Guidelines (PDF, 540.14KB, 68pg.)
- Midwife Policy Guidelines (PDF, 243.81KB, 29pg.)
- Nurse Practitioner Billing Guidelines (PDF, 1.01MB, 75pg.)
- Nurse Practitioner Policy Guidelines (PDF, 290.53KB, 43pg.)
- Office of Mental Health (OMH) Certified Rehabilitation Services Billing Guidelines (PDF, 178.07KB,51pg.)
- Office of Mental Health (OMH) Certified Rehabilitation Services Policy Guidelines (PDF, 11.15KB, 2pg.)
- Personal Care Billing Guidelines (PDF, 168.20KB, 49pg.)
- Personal Care Policy Guidelines (PDF, 89.24KB, 10pg.)
- Personal Emergency Response Services (PERS) Billing Guidelines (PDF, 160.89KB, 48pg.)
- Personal Emergency Response Services (PERS) Policy Guidelines (PDF, 52.53KB, 11pg.)
- Pharmacy Billing Guidelines (PDF, 284.76KB, 55pg.)
- Pharmacy Policy Guidelines (PDF, 320.58KB, 46pg.)
- Physician Billing Guidelines (PDF, 463.33KB, 78pg.)
- Physician Policy Guidelines (PDF, 617.80KB, 71pg.)
- Podiatry Billing Guidelines (PDF, 290.53KB, 43pg.)
- Podiatry Policy Guidelines (PDF, 11.48KB, 2pg.)
- Private Duty Nursing Services Billing Guidelines (PDF, 423.37KB, 63pg.)
- Private Duty Nursing Services Policy Guidelines (PDF, 86.54KB, 12pg.)
- Rehabilitation Services Billing Guidelines (PDF, 421.33KB, 61pg.)
- Rehabilitation Services Policy Guidelines
- Residential Health Care Billing Guidelines (PDF, 197.23KB, 56pg.)
- Residential Health Care Policy Guidelines (PDF, 228.60KB, 50pg.)
- School Supportive Health Services Program (SSHSP) Billing Guidelines (PDF, 187.24KB, 54pg.)
- School Supportive Health Services Program (SSHSP) Policy Guidelines (PDF, 53.77KB, 2pg.)
- Transportation Billing Guidelines (PDF, 359.71KB, 59pg.)
- Transportation Policy Guidelines (PDF, 162.84KB, 37pg.)
- Vision Care Billing Guidelines (PDF, 425.15KB, 62pg.)
- Vision Care Policy Guidelines (PDF, 263.31KB, 40pg.)
Provider HIPAA Instructions
HIPAA
- February 18 Deadline Extended for POS (PDF, 28.23KB, 1pg.)
- Notice to Providers that HIPAA exception processing will expire 12-29-04 (PDF, 28.23KB,1pg.)
HIPAA Companion Guide
- 270 Eligibility, Coverage or Benefit Inquiry Companion Guide (PDF, 645.44KB, 46pg.)
- 271 Eligibility, Coverage or Benefit Information Companion Guide (PDF, 1.51MB, 104pg.)
- 271 Sample Transaction
- 276 Health Care Claim Status Request Companion Guide (PDF,581.22KB, 35pg.)
- 277 Health Care Claim Status Notification Companion Guide (PDF, 2.29MB, 114pg.)
- 277 Claim Status
- 278 Health Care Services Review - Request for Review (DVS/SA) Companion Guide (PDF, 1.10MB, 73pg.)
- 278 Health Care Services Review – Inquiry (Confirmation) Companion Guide (PDF, 968.28KB, 56pg.)
- 278 Health Care Services Review - Request for Review (PA) Companion Guide (PDF, 968.28KB, 56pg.)
- 278 Health Care Services Review - Response (Confirmation) Companion Guide (PDF, 1.19MB, 85pg.)
- 278 Health Care Services Review - Response to Request for Review (DVS/SA) Companion Guide (PDF, 1.59MB, 96pg.)
- 278 Sample Transaction
- 820 Payroll and Other Group Premium Payment for Insurance Products Companion Guide (PDF, 512.18KB, 36pg.)
- 820 Sample Transaction
- 820 Supplementary File Information Companion Guide (PDF, 130.18KB, 8pg.)
- 820 Sample Transaction
- 835 Health Care Claim: Payment Advice Companion Guide (PDF, 935.71KB, 65pg.)
- 835 Health Care Claim: Payment Advice Companion Guide (PDF, 133.89KB, 8pg.)
- 837 Dental Health Care Claim: Supplemental (PDF, 63.83KB, 9pg.)
- 837 Health Care Claim: Dental Companion Guide (PDF, 1.60MB, 102pg.)
- 837 Dental Health Care Claim Supplemental Companion Guide (PDF, 63.83KB, 9pg.)
- 837 Health Care Claim: Institutional Companion Guide (PDF, 1.63MB, 138pg.)
- 837 Institutional Health Care Claim: Supplemental Companion Guide (PDF, 1.63MB, 138pg.)
- 837 Institutional: Managed Care Capitation Premium Billing Companion Guide (PDF, 708.45KB, 46pg.)
- 837 Health Care Claim: Professional Companion Guide (PDF, 1.68MB, 150pg.)
- 837 Health Care Claim: Professional Companion Guide for Non-Emergency Transportation (PDF, 1.36MB, 113pg.)
- 837 Professional Health Care Claim: Supplemental Companion Guide (PDF, 150.37KB, 13pg.)
- National Council for Prescription Drug Programs (NCPDP) Companion Guide (PDF, 337.23MB, 28pg.)
- National Council for Prescription Drug Programs (NCPDP) Companion Guide (PDF, 239.42KB, 23pg.)
- Supplementary Document for Taxonomy Usage (PDF, 490.64KB, 19pg.)
- Technical Supplementary Companion Guide (PDF, 164.22KB, 45pg.)
Provider HIPAA Letter
- Announcement of Oct 6, 2004 HIPAA deadline
- Announcement of eMedNY Phase II Transition Plan
- HIPAA Testing Available on EDIFECS
- Letter to PC providers that the Elig Field Software is not HIPAA-compliant and will not work after October 6, 2004
- Letter to Pharmacy providers sending 3.2 and 3A that they must send 5.1 HIPAA by Oct 6, 2004
- Letter reminding providers about the Oct 6, 2004 HIPAA compliance deadline
- Letter to PACES users stating that DOH will be discontinuing support for PACES
- Notice to providers that HIPAA exception processing will expire Dec 29, 2004
- Reminder letter on the Oct. 6, 2004 deadline for HIPAA
Provider Manual
- Manuals - For All Specialties
- Foster Family Care
- Home and Community-Based Services Medicaid Waiver for Individuals with Traumatic Brain Injury
- Home Health Services
- Hospice
- Long Term Home Health Care Program
Transportation
- Transportation & DME Providers: Enrollment Requirements for Each Operating Location
- Separate Provider Identification Number Required for Each Dispatching Operating Location
