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.
To establish that each release of health information was properly executed the original authorization is retained by the Department of Health. As such, authorizations cannot be copies, are good for one use only, and must be delivered to the address below: faxed or emailed requests are not accepted.
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 or to a minor Member's parent or guardian, please refer to the section below entitled Requesting the Release of 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 Authorization to Release Protected Medicaid Member Information to a Third Party (DOH-5198) (PDF, 160KB).
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.
A copy of the authorization form and the guidelines for submitting it can be found here: Authorization to Release Protected Medicaid Member Information to a Third Party (DOH-5198) (PDF, 160KB). 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. Except for the parent and natural guardian of a Medicaid Member who is a minor, persons signing on behalf of a Member must supply documentation proving their authority to act for the Medicaid Member.
- The authorizations must have original, "wet ink" signatures. Copied signatures 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 that have not been initialed for approval by the signer.
- 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:Medicaid Data Warehouse - CDRs
NYSDOH – MISCNY
ESP P1-11S Dock J
Albany NY 12237
Judicial subpoenas of Medicaid confidential data should be directed to:Michael G. Bass, Director
Bureau of Litigation - Division of Legal Affairs
New York State Department of Health
Empire State Plaza - Corning Tower Building - Room 2438
Albany NY 12237
Allow time for approval and processing. Authorized requests normally generate a response within 30 days. Judicial subpoenas must be approved by the Division of Legal Affairs before processing and normally generate a response in 4-6 weeks.
The Bureau does not have the personnel or other resources to give status updates during the first 30 days of processing or to confirm deliveries. Requestors may call (518) 649-4208 to make status inquiries 30 days after mailing or to ask questions about the request process at any time.
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 complete the form, Member Request for Specific Protected Medicaid Health Information (DOH-5199) (PDF, 144KB), 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.