New York State Medicaid Update - May 2018 Volume 34 - Number 5

In this issue …

Important Message Regarding Medicare Part B Claims Submitted by Pharmacies

Effective May 24, 2018, pharmacies will be allowed to submit Medicare B drugs via the medical claim format, for automated crossover claims only when billing Medicaid secondary for Medicare Part B patient responsibility amounts. This is the result of a system fix to correct an error that occurred with the implementation of the April 21, 2016 reimbursement logic for Medicare B pharmacy claims.

For more information on Medicare Part B reimbursement please view the April 2016 Medicaid Update.

Pharmacy Providers will now receive the response returned on their electronic 835, PDF or paper Remittance Advice. eMedNY uses the Default Electronic Transmitter Identification Number (ETIN), linked to your Medicaid Management Information System (MMIS) Provider Number/National Provider Identifier, for reporting automated Medicare crossover claims on your electronic or PDF remittance. In order to receive these Medicare crossover claims on your remittance statements, you will need to verify you have selected a Default ETIN, and make sure the ETIN is current with its Certification.

Should you need to select or change the Default ETIN on file with eMedNY, you would submit the Default Electronic Transmitter Identification Number Selection Form. This form and the rest of our Provider Maintenance Forms can be found on our website:

Please contact the eMedNY Call Center at(800) 343–9000 for questions regarding this billing requirement or any billing issue.

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Additional Codes Added to the Nurse Practitioner Fee-for-Service Fee Schedule

Effective April 1, 2018, the following procedure codes have been added to the Nurse Practitioner fee-for-service (FFS) Medicaid fee schedule:

57454Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocervical curettage
57455with biopsy(s) of the cervix
57456with endocervical curettage
57460with loop electrode biopsy(s) of the cervix
57461with loop electrode conization of the cervix

Questions regarding Medicaid FFS billing, please contact eMedNY Provider Services at (800) 343–9000. Policy questions regarding Medicaid FFS please contact the Office of Health Insurance Programs (OHIP), Division of Program Development and Management at (518) 473–2160.

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Coverage of Kymriah™ (tisagenlecleucel) Expanded to Include Diffuse Large B-Cell Lymphoma

The cellular-based gene therapy, Kymriah™ (tisagenlecleucel), was approved by the FDA in August 2017 for the treatment of patients under age 25 with refractory or relapsed acute lymphoblastic leukemia (ALL). On May 1, 2018, the FDA approved Kymriah™ for an additional indication, relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy including diffuse large B-cell lymphoma (DLBCL) not otherwise specified, high grade B-cell lymphoma, and DLBCL arising from follicular lymphoma in adults. Medicaid coverage of Kymriah™ will include this new indication and any future FDA approved indications.

For information related to the initial coverage of Kymriah™ and for fee-for-service (FFS) billing guidance, please see the November 2017 Medicaid Update article.


Medicaid FFS billing should be directed to eMedNY Provider Services at (800) 343–9000. Policy questions regarding Medicaid FFS may be directed to the Office of Health Insurance Programs (OHIP), Division of Program Development and Management at (518) 473–2160. Questions regarding Medicaid Managed Care (MMC) reimbursement and/or documentation requirements should be directed to the enrollee's MMC plan.

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Important Reminder for Expedited/Priority and P.O. Box Mailing Addresses

Please use the following chart when sending mail to eMedNY. Identify the type of correspondence to be mailed, and mail to the address below using the appropriate P.O. Box and 4-digit ZIP Code extension:

P.O. Box (see below)
Rensselaer, New York 12144-

Please note: If you are sending priority/expedited mail (Fed Ex, UPS, USPS), use the physical address format below. Forms sent priority delivery will still be processed in the standard timeframe.

327 Columbia Turnpike
ATTN: Box ____ (use the corresponding Box number from the table below)
Rensselaer, NY 12144
P.O. BoxZIP Code ExtensionDescription of ContentsForm Types
46004600Prior Approval and Prior Authorization RequestsEMEDNY-361402 (Dental)
EMEDNY-361502 (Prescription Drugs, Physician, DME, PDN, Vision)
EMEDNY-283202 (Hearing Aid)
EMEDNY-126001 (Level of Care)
PA Additional Information
46014601ClaimsEMEDNY-150003 (HCFA)
EMEDNY-000201 (Form A)
EMEDNY-000301 (Pharmacy)
46024602Threshold Override ApplicationsEMEDNY-000105 (TOA)
46034603Provider Enrollment Applications/RevalidationAll Fee-For-Service and Rate-Based Enrollment Packets
46044604Edit ReviewProvider Submitted documentation (Medicare EOMBs) to support claims pending for MMIS Edits 00127 and 01283 only
46054605Remittance RetrievalProvider Requests for copies of remittance statements
46064606Additional InformationProvider Enrollment Additional Information Form with attachments
46104610Provider MaintenanceProvider maintenance (update) forms and related Correspondence ex: Change of Address
46148614Electronic Form RequestsElectronic Certifications
ETIN Applications
Security Packet B
Electronic/PDF Remittance Request
Electronic Prior Approval Request
Remittance Sort Request
Pended Claim Recycle Request
Request to Disaffiliate/Delete an ETIN
46168616Electronic Funds TransferElectronic Funds Transfer Enrollment Forms

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NY Medicaid EHR Incentive Program Update

The NY Medicaid Electronic Health Record (EHR) Incentive Program promotes the transition to EHRs by providing financial incentives to eligible professionals and hospitals. Providers who demonstrate Meaningful Use of their EHR systems are leading the way towards Interoperability, which is the ability for healthcare providers to exchange and use patient health records electronically. The ultimate goal is to increase patient involvement, reduce costs and improve health outcomes. Since December 2011, over $913 million in incentive funds have been distributed through 34,248 payments to New York State Medicaid providers. Since 2011, Eligible Professionals & Eligible Hospitals have received:

Number of Payments:Distributed Funds:

The 2017 attestation period will be opening soon, but let's talk about what you should be doing now for payment year 2018. It's not too early to prepare for 2018 so are you doing everything you can?

We're almost halfway through the year and we know it's too early to attest for 2018, but it's not too early to prepare. We have some tips and resources that will help you right now to prepare your records so that when it's time for your 2018 attestation, you're ready.

Here are some easy tasks you can complete and check off of your to-do list:

What else can you do now to prepare for 2018 Attestation?

Visit our Website

You can find all of the information below, and more, on our website -

Some Information Includes:

  • Payment Year 2018 Requirements – Modified Stage 2 and Stage 3
  • Eligible Hospital Requirements
  • Public Health Reporting Objective Information
  • Post-Payment Audit Guidance
  • Frequently Asked Questions (FAQs)
  • Materials and Information – Document Repository

Listserv – Have program announcements sent right to your inbox!

The NY Medicaid EHR Incentive Program publishes listserv messages each month, and additional messages when there are important changes to the program that will impact eligible providers. In the listserv you will find:

  • Updates regarding the NY Medicaid EHR Incentive Program Administration
  • Attestation system (MEIPASS) announcements and updates
  • Attestation dates and deadlines
  • Current quarter webinar schedule
  • Program requirements
  • Links to training resources and tutorials
  • CMS final rule releases and programmatic changes


To register for the NY Medicaid EHR Incentive Program listserv:

You can also register for the MU Public Health Reporting listserv for information on the Public Health Reporting Objective for the EHR Incentive Program:

Attend Webinars

The NY Medicaid EHR Incentive Program hosts webinars and we have several sessions over the next couple of months that are focused on preparing for payment year 2018. To sign up for the webinars and additional information, please visit our webinar calendar here:

phone icon Questions? We have a dedicated support team ready to assist. Contact us at 877-646-5410, option 2 or

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The Medicaid Update is a monthly publication of the New York State Department of Health.

Andrew M. Cuomo
State of New York

Howard A. Zucker, M.D., J.D.
New York State Department of Health

Donna Frescatore
Medicaid Director
Office of Health Insurance Programs