Information for Pharmacies

Medicaid Pharmacy Program Information for Pharmacies

Pharmacies that are not enrolled in the FFS program as billing providers must enroll, in order to continue serving Medicaid Managed Care members. Instructions for checking enrollment status, and enrollment tips can be found at the eMedNY Provider Enrollment website.
  • Member Identification Number:
    Beginning April 1, 2023. Pharmacies will bill the Medicaid FFS Program using the Client Identification Number (CIN), which can be found on both the FFS Client Benefit identification Card (CBIC) or the member´s MC plan card.
    The Client Identification Number or CIN is a unique number assigned to each Medicaid member. This number is used by the pharmacy to submit pharmacy claims to Medicaid FFS. All Medicaid members are assigned a CIN even if they are enrolled in a Medicaid managed care (MMC) plan. The CIN is located on all member cards including MMC plan cards. On some MMC cards it is referred to as CIN, however other MMC cards may identify it as Program ID, Member ID, or ID#. While in some cases it may be embedded into a longer number the CIN is always represented in this format: "AA11111A". For assistance locating the CIN on an MMC plan card, please visit the NYS Pharmacy Benefit Information Center website. From the Homepage, providers can select a plan to display an image of the plan card and where the CIN is located.
  • Bank Identification Number (BIN) and Processor Control Number (PCN):
    For submitting FFS claims to Medicaid via NCPDP D.0, the BIN number is required in field 101-A1 and is "004740". The PCN (Processor Control Number) is required to be submitted in field 104-A4. The PCN has two formats, which are comprised of 10 characters:
    • First format for 3-digit Electronic Transaction Identification Number (ETIN):
      "Y"- (Yes, read Certification statement) -(1)
      Pharmacists Initials- (2)
      Provider PIN Number- (4)
      3-digit ETIN- (Electronic Transaction Identification Number)- (3)
    • Second format for 4-digit ETIN:
      Pharmacist Initials- (2)
      Provider PIN Number- (4)
      4-digit ETIN- (Electronic Transaction Identification Number)- (4)

Pharmacies can check a member's eligibility status by using an E1 transaction, ePACES, or the touchtone telephone verification system. Please review the following chart for the information necessary to use these verification methods:

Method Summary Resources
E1 Transaction Instructions to complete this transaction begin on page 10 of the NCPDP D.0 Standard Companion Guide. NCPDP D.0 Standard Companion Guide (PDF)
ePACES Providers must have an ePACES account and the following information about the member:
  • First and Last Name
  • Date of Birth
  • Social Security Number (SSN) or Client Identification Number (CIN)
  • Gender
Touchtone Telephone Verification System Providers must have the following information:
  • CIN
  • Provider's National Provider Identifier (NPI) or MMIS Number
  • Ordering Provider NPI (if applicable)
NYS Program's MEVS Instructions for Completing a Telephone Transaction (PDF)