DOH Medicaid Update
[Hint: Use all variations of whole words (alone or in phrases), separated by commas, for best results (e.g., 72 hour, 72 hours).]
Special Edition COVID-19 Issues
Current Issue: August 2021
Archived Issues
2021, 2020, 2019, 2018, 2017, 2016, 2015, 2014, 2013, 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2003, 2002, 2001, 2000 or 1999
Provider Directory
- Current Provider Directory
- For historical Provider Directory listings, please find the section in most archived PDF version issues.
Editor's Office
- Comments and Suggestions Regarding this Publication or web site?
Readers can contact the editor, Angela Lince, at medicaidupdate@health.ny.gov. - Each new issue of the Medicaid Update Newsletter is announced via email using the Medicaid Update LISTSERV. If readers want to sign up for the Medicaid Update LISTSERV, please email the request to: medicaidupdate@health.ny.gov.
Search Functions
- Recommended: The "Search All Medicaid Update Issues" box at the top of this page performs a search of any words used within only Medicaid Update articles. Search results are a combination of closeness-of-match and recency of posting.
- The categories in "Medicaid Update Topics A to Z" (see section below) present articles that have been grouped over time through renaming or expansion.
- For a quick search of article titles, readers can open the entire article list by selecting the "DOH Medicaid Update Index - A to Z" web page (to which the topics are linked) and then performing a Windows ™ "Find" by striking Ctrl-F on the keyboard or by menu in the browser of their choice.
- The final method is not recommended. Readers can use a search engine such as Bing or Google but it will pull in any outdated copy saved elsewhere without permission and can only use the keywords as encoded in the PDF file versions.
Medicaid Update Topics A to Z
A
- Abortion
- Acthar Gel, H.P. ® (repository corticotropin injection)
- Actual Acquisition Cost / Cost of Dispensing Project
- Actual Acquisition Costs (AAC)
- ADAKVEO ® (crizanlizumab-tmca)
- Address Change
- Adjustments
- Adult Care Facility
- Adult Day Health Care (ADHC)/ AIDS Aduly Day Health Care (AIDS ADHC) Programs
- Advance Care Planning/Health Care Proxy
- Agents for Pulmonary Fibrosis
- Air Ambulance
- Alcohol Abuse Services
- Alien Eligibility
- Allergy
- Alternate Level of Care (ALC) days
- Alzheimer's Disease
- Ambulance
- Ambulatory Care
- Ambulatory Patient Group (APG)
- American Heart Association
- Americans with Disabilities Act (ADA)
- Anesthesia
- Angiotension Receptor Blockers
- Antibiotic Resistance
- Antihistamines
- Antimicrobial Resistance
- Antipsychotics
- Anti-Retrovirals (ARV)
- Apnea
- Arthritis
- Article 16
- Article 28
- Assisted Living Program (ALP)
- Asthma
- Asthma Educators
- Atypical Antipsychotic Drugs
B
- Barbiturates
- Bariatric Surgery
- Bed Safety
- Behavior Health Services
- Benzodiazepines
- Billing
- Blood Factors (human plasma-derived or recombinant)
- Blood Pressure Machine
- Booster Seats
- Botox ® (onabotulinumtoxinA)
- Brand Name Drugs
- Breast Cancer
- Breastfeeding Support Services
- Buprenex (Buprenorphine) and concurrent opioids
- Buy-in
C
- Cancer unspecified
- Cardswipe
- Care-at-Home (CAH), III, IV, VI
- Carve Out
- Case Management/Comprehensive Case Management
- Catapres-TTS ® (clonidine)
- Center for Operational Excellence (COE)
- Centers for Disease Control and Prevention (CDC)
- Central Nervous System (CNS) Stimulant
- Certified Home Health Agency (CHHA)
- Cervical Cancer
Cesarian Section (C-Section)See Elective Delivery- Chantix ® (varenicline)
- Check Amount
- Chemical Dependence
- Child Care Agencies
- Child Health Plus
- Child/Teen Health Program (CTHP) / Early and Periodic Screening Diagnosis and Treatment (EPSDT)
- Children and Youth Evaluation Service (C-YES), Independent Entity
- Children in Fostercare
- Citizenship Documentation Requirements
- Claim Denial Reasons
- Claim Filing Indicator
- Claim Modifiers
- Claims
- Clinic: Freestanding
- Clinic: Outpatient
- Clinic: Outpatient Hospital-based
- Clinic: School-based
- Clinic: unspecified
- Clinical Drug Review Program (CDRP)
- Clinical Psychologists
- Codes
- Coinsurance
- Collaboration Requirement
- Colorectal Cancer
- Community First Choice Option (CFCO)
- Compliance Program Requirement
- Compounded Prescription
- Compression Stockings
- Compulsive Gambling
- Condition Codes
- Consumer Fact Sheets: Chronic Conditions
- Contact Information
- Contraception / Emergency Contraception
- Controlled Substance
- Coordination of Benefits (COB)
- Co-payment
- Coronary Angiography
- Coronavirus disease (COVID-19)
- Cost of Dispensing (COD)
- Cost Sharing
- Coverage
- COVID Alert NY application
- Credentialed Alcoholism and Substance Abuse Counselor (CASAC)
- Cystine Depleting Agents
D
- Day Habilitation Services
- Deficit Reduction Act (DRA)
- Delay Reason Codes
- Delivery System Reform Incentive Payment (DSRIP) Program
- Dental/Orthodontia Services
- Dentists
- Developmental Screening
- Diabetes
- Diabetes Educators
- Diabetes Self-Management Training (DSMT)
- Diagnosis Code
- Diagnosis Related Group (DRG)
- Dialysis
- Disability
- Discharge Planning (Safely)
- Disease Management
- Dispense As Written / Product Selection Code
- Dispense Brand Drugs when Less Expensive Program
- Dispensing Validation System (DVS) transactions within ePACES
- Disqualified Prescriber
- DOH Web Site
- Dose Optimization
- Doula Pilot Program
- Drug Utilization Review (DUR)
- Dual Eligible population
- Dual Energy X-ray Absorptiometry (DEXA/DXA) scan
- Durable Medical Equipment: not specified
E
- Early Fill Edit
- Ebola
- Edits
- Elderly Pharmaceutical Insurance Coverage (EPIC)
- Elective Delivery (Elective C-section and Induced Labor)
- Electronic Funds Transfer (EFT)
- Electronic Health Record (EHR)
- Electronic Medicaid Eligibility Verification System (EMEVS)
- electronic Provider Assisted Claim Entry System (ePACES)
- Electronic Transmitter Identification Number (ETIN)
- Electronic Visit Verification (EVV) System/Program
- Eligibility
- eMedNY
- Emergency Medical Condition
- Emergency Services
- Encounter Requirements
- Enrollment
- Enteral Therapy/Formulae
- e-Prescriber
- Erectile Disfunction (ED) Drugs
- Essential Plan (EP)
- Exclusive Pharmacy Network Initiative
- Expenditure Caps
F
- False Claims
- Family Health Plus (FHPlus)
- Family Planning
- Family Planning Benefits Program (FPBP)
- Family Planning Extension Program (FPEP)
- Federal Povery Levels (FPL)
- Federally Qualified Health Center (FQHC)
- Fidelis Members
- 5010 Remittances
- Footwear
- Forms
- Fraud
- Frequency/Quantity/Duration (F/Q/D) Program
- Fully Integrated Duals Advantage (FIDA) Demonstration
- Fulyzaq ® (crofelemer)
- Functional Electrical Stimulation (FES)
- Fungal Meningitis
G
H
- H. Pylori
- Harm Reduction Services (HRS) / Syringe Exchange Programs (SEP)
- Health and Recovery Plans (HARPs)
- Health Data NY
- Health Home Tracking System (HHTS)
- Health Insurance Portability and Accountability Act (HIPAA)/Clearinghouse
- Health Management Organization (HMO)
- Healthy NY
- Hearing Aids
- Hearing Services
- Hemophilia
- Hepatitis C
- Herceptin ® (trastuzumab) and other drugs provided in multi-use vials
- Home and Community Based Services (HCBS)
- Home Health Aide Services
- Home Health Care
- Homemaker Services
- Hospice
- Hospital
- Human Immunodeficiency Virus (HIV)
- Hypertension
I
- Idiopathic Short Stature
- IDNYC
- Immigrants
- Immunization/Vaccination
- Immunizers
- Implantable Infusion Pump (IIP)
- Implementation Schedule
- Incontinence
- Indicator Codes
- Individual Day Habilitation (OPWDD)
- Individualized Residential Alternatives (IRAs)
- Individuals with Developmental Disabilities
- Infants with Disabilities
- Influenza (Flu)
- Information: Support, Posters, Brochures, Frequenty Asked Questions (FAQs)
- Inhaled Antibiotics for Cystic Fibrosis
- Inhaled Corticosteroids (ICS)
- Injectables
- Inquiry Response
- Institutionalized Spouse
- Integrated Services
- Integrated Voice Response (IVR) System
- International Statistical Classification of Disease and Related Problems, version 10 (ICD-10)
- Interpreter Services / Language / Translation
J
K
L
- Laboratory/Screening/Testing (including Lead, Genetic)
- Law
- Lawsuit
- Limits on Benefits
- linagliptin
- Local Department of Social Service (LDSS)
- Long Term Care (LTC)
- Long Term Home Health Care Program (LTHHCP)
- Long-acting Beta-2 Agonists
- Loss of Medicaid Records
- Low Birth Weight
- Lower Back Pain
- Luxturna ™ (voretigene neparvovec-rzyl)
- Lynch Syndrome
M
- Magnetic Resonance Imaging (MRI)
- Mail Order Pharmacies
- Malnutrition
- Mammography Services
- Managed Long Term Care (MLTC)
- Management Addiction Treatment Services (MATS)
- Mandatory Generic Drug Program (ManGen)
- Marinol ® (dronabinol)
- Medicaid Card
- Medicaid Evidence-Based Dossier Review Process
- Medicaid Fee For Service (FFS)
- Medicaid Health Homes
- Medicaid Managed Care (MMC)
- Medicaid Management Information System (MMIS)
- Medicaid Prescriber Education Program
- Medicaid Redesign Team Project
- Medicaid Therapy Management (MTM)
- Medicaid Update
- Medicaid Utilization Threshholds (MUTs)
- Medically Fragile Children (MFC)
- Medicare (Part not specified)
- Medicare Card
- Medicare Crossover Claims
- Medicare Part A
- Medicare Part B
- Medicare Part C
- Medicare Part D
- Medication
- Member Service Request
- Members with Institutionalized Spouse
- Mental Health
- metformin
- Methamphetamine Laboratory Recognition
- Metozolv ODT ® (metoclopramide orally disintegrating tablets)
- Midwives
- Modified Adjusted Gross Income (MAGI)
- Money Follows the Person (MFP) Demonstration Program
- Mosquito Repellent
N
- Naloxone
- National Council for Prescription Drug Programs (NCPDP) Version D.0 transactions
- National Drug Code (NDC)
- National Healthcare Decisions Day
- National Healthy Mothers Healthy Babies, partnership program text4baby
- National Provider Identifier (NPI)
- Neonatalogists
- Net Available Monthly Income (NAMI)
- New York City Department of Health and Mental Hygiene (NYC DOHMH)
- New York State of Health (NYSoH)
- Newborns
- Non-drug items
- Non-Steriodal Anti-Inflammatory Drug (NSAID)
- Not-qualified-to-prescribe
- Nuedexta (dextromethorphan and quinidine)
- Nurse Family Partnership (NFP)
- Nurse Practitioner
- Nursing Home
- Nutrition
O
- Obesity
- Observation
- Occupational Disease
- Occupational Health Clinic Network (OHCN)
- Occupational Therapy (OT)
- Office for Persons with Developmental Disabilities (OPWDD/OMRDD)
- Office of Mental Health (OMH)
- Office of the Medicaid Inspector General (OMIG)
- Opioids
- Optical Providers
- Optical/Vision/Optometry
- Optometrists
- Ordered Ambulatory Services
- Ordering/Prescribing/Referring/Attending (OPRA) Providers
- Origin Codes
- Orthopaedic Services
- Other Insurance
- Over the Counter (OTC)
- Overpayments
- Oxygen Concentrator
P
- Pasteurized Donor Human Milk (PDHM)
- Patient Centered Medical Home (PCMH)
- Patient Education Tools
- Patient Status Codes
- Payment Accuracy Measurement (PAM)
- Payment Error Rate Measurement (PERM)
- Payment Policy
- Payments
- Pediatricians
- Percutaneous Coronary Intervention (PCI, angioplasty)
- Peripheral Edema
- Personal Care Services
- Personal Emergency Response System (PERS)
- Pertussis (Whooping Cough)
- Pharmacists
- Pesticide Poisoning
- Pharmacotherapy
- Pharmacy (general)
- Pharmacy Benefits
- Pharmacy Services
- Physical Therapy (PT)
- Physician Assistant
- Physicians
- Pharmaceutical Shortage
- Podiatrists
- Podiatry
- Point of Service (POS) Device
- Policy
- Portable Document Format (PDF) electronic remittance
- Positron Emission Tomagrapghy (PET) and Tracers
- Post-Operative Follow-up
- Post-Operative Observation
- Postpartum Period followup
- Practitioner-Administered Drugs
- Pre-diagnostic Procedure Codes
- Preferred Drug Program (PDP)
- Preferred Physicians and Children Program (PPAC)
- Prenatal Care
- Prenatal Testing / Prenatal Carrier Testing
- Prepaid Mental Health Plans
- Prepayment Review
- Prescriber Prevails
- Prescribers
- Prescription Serialized Number
- Present on Admission (POA) Indicator
- Presumptive Eligibility
- Prevention Agenda
- Primary Care Provider / Prepaid Capitation Plan (PCP) - split this!
- Primary Care Rate Increase (PCRI)
- Primary Care Service Corps (PCSC)
- Primary Care Services
- Primary Payer
- Prior Authorization
- Private Duty Nurse
- Private Duty Nusing
- Program of All-Inclusive Care for the Elderly (PACE)
- Protease Inhibitors
- Protected Health Information (PHI)
- Proton Pump Inhibitors (PPI)
- Provider
- Provider Enrollment
- Provider Identity Theft / "Medicaid Mills"
- Provider Manual
- Provider Self Assessment
- Provider Training / Seminars
- Proxy Form
- Psychiatric Services
- Psychotherapy
- Public Health Emergency Response Network Pharmacy Program (PHERN PP)
Q
R
- Radiation Treatment
- Rate Code
- Rebates
- Recipient Exception (RE) Codes
- Recipient Information
- Recipient Name Search and Check Amount Inquiry
- Reciprocity
- Recordkeeping Requirements
- Referrals
- Reflex testing
- Rehabilitation
- Reimbursement/Rates
- Remittance
- Remittance News - Electronic
- Residential Health Care Facility
- Residential Treatment Facility
- Resource Attestation
- Respite Services
- Revatio ® (sildenafil)
- RU-486 (Mifeprex ®, mifepristone)
S
- Same Date of Service
- Schizophrenia
- School Supportive Health Services Program (SSHSP)
- Screening, Brief Intervention and Referral to Treatment (SBIRT) Services
- Second Generation Antipsychotics (SGA)
- Secondary Claims
- Self-Direction / Self-Directed Services / Consumer-Directed
- Serostim ® (somatropin)
- Service Authorization
- 17 Alpha-hydroxyprogesterone Caproate
- Sharps
- Shingles
- Short-Acting Opioids
- Sickle Cell Disease
- Skin Substitutes
- Smoking/Tobacco Cessation
- Smoking Cessation Advertisement
- Social Work Services
- Soy Formula
- Special Needs
- Speech Generating Device
- Speech Therapy (ST)
- Spinal Muscular Atrophy
- Spousal Impoverishment
- Standing Orders
- Statins
- Stretcher Van
- Substance Abuse
- Success Stories
- Suffolk County
- Supervised Community Residences (CRs)
- Supervising Pharmacists
- Supplies (Medical-Surgical)
- Surgery
- Surgical First Assistants
- Symbyx ® (fluoxetine and olanzapine)
- Synagis ® (palivizumab)
- systemic immunomudulators
T
- Taxes/Internal Revenue Service (IRS)
- tazarotene
- Telehealth/Telemedicine
- Temporary Medicaid Authorization
- Third Party Health Insurance Information
- Toll-Free Helplines
- Topamax ® (topiramate)
- topical antifungals for Onychomycosis
- Topical Oxygen Wound Therapy (TOWT)
- Total Asset Protection Plan
- Trading Partner Agreements (TPAs)
- Training and Education for the Advancement of Children's Health at OMH (Project TEACH)
- 340B Drug Pricing Program
- Transcutaneous Electrical Nerve Stimulation (TENS)
- Transgender Services
- Transition to Managed Care
- Transportation
- Traumatic Brain Injury (TBI)
- Trisomy 21, 18 and 13
- Tuberculosis
U
- Uniform Assessment System for New York (UAS-NY)
- Universal Product Code (UPC)
- Uroxatral ® (alfuzosin)
- Utilization
V
- Vaccines for Children (VFC) Program
- Vehicle Modifications
- Ventilator
- Verifone
- Viral Prescription Pad
- Viscosupplementation of the Knee
- Voluntary Foster Care Agency (VFCA)
