Obtaining Payment Records
Medicaid regulations allow Medicaid members to obtain copies of their Medicaid payment records directly or to authorize the release of their records to a third party, usually legal counsel. The Health Insurance Portability and Accountability Act (HIPAA) requires the Medicaid program to have an authorization from members before releasing their protected health information for any purpose.
In order to have Medicaid payment records sent to a third party, please refer to the section below entitled Requesting the Release of Information to a Third Party. In order to have Medicaid payment records sent directly to a Medicaid member, please refer to the section below entitled Requesting the Release Information to a Medicaid Member.
Requesting the Release of Information to a Third Party
Any request to release Medicaid payment records to another party must consist of both a letter of request, either from the third party or from the Medicaid member and an original authorization see attached form (PDF, 211KB, 2pg)
The letter requesting Medicaid payment records must include:
- the Medicaid member's name AND date of birth,
- the Medicaid Member Client Identification (CIN) Number or Social Security Number, preferably both, and
- the dates of service the report will cover.
To obtain a copy of the authorization form and the guidelines for submitting it, click on the following link: NYS DOH OHIP Authorization to Release Medicaid Protected Information to a Third Party (PDF, 208KB, 2pg). Copies of this document may also be obtained by contacting the New York State Department of Health Public Web Site Administration at email@example.com.
The following are requirements for an authorization to be considered valid:
- The authorization must give the name and address of the party that the records are to be sent to.
- The authorization must be signed by the Medicaid member or by a person having legal authority to sign for the member; persons signing on behalf of a member must supply documentation proving their authority to act for the Medicaid member.
- The authorizations must be originals. Photocopies are unacceptable.
An authorization is not valid and will not be honored by the Office of Health Insurance Programs if any of the following apply:
- The expiration date on the authorization has passed, or a year has passed since the authorization was signed.
- The authorization contains whiteout, substitutions, or deletions.
- The authorization has not been filled out completely.
- The authorization bars release of certain information or requires NYSDOH to make redactions before release.
- The authorization is known to have been revoked.
- Any material information in the authorization is known by the covered program to be false.
Send the request to:
NYSDOH, Medicaid Information Service Center of New York
800 North Pearl Street, Room 322
Albany, New York 12204
Judicial subpoenas of Medicaid confidential data should be directed to:Harold Rosenthal, Esq.
Bureau of Litigation, Division of Legal Affairs
New York State Department of Health
Empire State Plaza, Corning Tower Building, Room 2438
Albany, New York, 12237.
Requesting the Release of Information to a Medicaid Member
If you are a Medicaid Member, Federal regulations permit the release of Medicaid payment records directly to you. If you want to request this information, please click his link and complete the form, (PDF, 182KB, 1pg) and send it to the address on the bottom of the form.
Copies of this document may also be obtained by contacting the New York State Department of Health Public Web Site Administration at firstname.lastname@example.org.