Individual Pre-validation File

New York State Department of Health – Office of Health Insurance Programs
NY Medicaid EHR Incentive Program

The NY Medicaid EHR Incentive Program offers pre–validation services for eligible Providers who would like program support to assist in validating their Medicaid Patient Volume before attesting.

Individual Providers may utilize the pre–validation services if they have determined the following information that they intend to submit with their attestation:

90–day reporting period for Medicaid Patient Volume
Medicaid encounter data
Total patient encounter data

Please complete this file and return to NY Medicaid by email to

Provider Name:  
Provider NPI:  
Pre–validated Payment Year:  
Reporting Period Start Date:  
Reporting Period End Data:  
Provider Medicaid Encounters:  
Provider Total Encounters:  

Please take note of the following important information:

  1. If you supervise other Providers that bill under your NPI please fill out the second tab of this excel document, titled "Supervise Other Providers."
  2. If you render care at multiple locations please fill out the third tab of this excel document, titled "Render Care at Multiple Locations."
  3. All Provider attestations are subject to audit. In the event of an audit, it may be necessary to produce documentation of all encounters included in the numerator or denominator before using any data in this file for attestation, Providers should verify that the "FFS Encounters" reported here match their records of fee-for-service claims paid by NY Medicaid. In the event of a discrepancy, Providers should consult with their billing agency/department or the NY Medicaid EHR Incentive Program Support team for advice on how to properly use this data set for attestation.

    To contact the NY Medicaid EHR Incentive Program support team:
    1 (877) 646–5410, Option 2
Below is an explanation of the fields contained in this data set.
Provider Name: The name of the Provider that is requesting pre–validation.
Provider NPI: The National Provider Identifier.
Pre–validated Payment Year: The payment year the Provider wants to be pre–validated (e.g. 2015 or 2016).
Reporting Period Start Date: 90–day patient volume reporting period start date.
Reporting Period End Data: 90–day patient volume reporting period end date.
Individual Medicaid Encounters: The number of Medicaid patient encounters attributable to the Provider´s NPI on any given date of service during the 90–day patient volume reporting period according to the definition of "encounter" specified in the NY Medicaid EHR Incentive Program.

Please visit FAQ ID EP07 for the definition of an encounter.
Total Encounters: The number of total encounters attributable to the Provideral NPI on any given date of service during the 90–day patient volume reporting period.
Render Care Outside the Organization: Does the Provider work at this Organization full–time or part–time. If the Provider is part–time within the Organization please indicate ´Y´. ;
Medicaid Encounter Date: The date the services rendered occurred.
NPI that Billed Service: The Provider NPI that billed for the Medicaid Encounter.
Payment Received Did the Provider receive payment for Medicaid Encounter. If yes, please indicate ´Y´.
Medicaid Claim Type (FFS, MC, FHP) FFS = Medicaid Fee–for–service MC = Medicaid Managed Care FHP = Family Health Plus
Medicaid Patient Number The unique identifier of the Medicaid recipient.
ZIP Code (+4) The five–digit zip code plus four additional digits.