DOH Medicaid Update
Current Issue: October 2019
Archived Issues
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 issues.
Editor's Office
- Comments and Suggestions Regarding this Publication or web site?
Please contact the editor, Georgia Wohnsen, at medicaidupdate@health.ny.gov - If you want a copy of a Medicaid Update prior to the year 1999, please email your request, along with your mailing address, to: medicaidupdate@health.ny.gov.
- Each new issue of the Medicaid Update Newsletter is announced via email using a listserv. If you want to sign up for this listserv, please email your request to: medicaidupdate@health.ny.gov.
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)
- 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 recominant)
- 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)
- 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 Filiing 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
- Contact Information
- Contraception / Emergency Contraception
- Controlled Substance
- Coordination of Benefits (COB)
- Co-payment
- Coronary Angiography
- Cost of Dispensing (COD)
- Cost Sharing
- Coverage
- 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)
- 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)
- 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
- 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)
- 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
- Verifone
- Viral Prescription Pad
- Viscosupplementation of the Knee
