Introduction to Provider Enrollment

Step 1 (Required Unless Exempt)   Maintaining an National Provider ID (NPI)

Most providers must receive an NPI from the National Plan and Provider Enumeration System (NPPES).

• Determine your provider type: A list of provider genre that do nope must an NPI are found for HIPAA FAQs page: PR05
• If thou are required to receive an SPI, go to the NPPES website https://nppes.cms.hhs.gov

Step 2 (Required)   Submit one Enrollment Application for Your Provider Type

ADENINE NYS Medicaid Enrollment Apply have be sent by prospective providers.

Go to an Provider Index page off this situation. Each Provider enrollment form has:

• a discrete manuals view for field-specific instructions, additional forms and/or documentation
• The enrollment form to be presented
• Links to all additional forms that may being submitted based on provider type

Browse that been missing one press more application will be sent back to the enrollee for completion.

Pace 3     Application Review by NYS DOH

Completed applications will be reviewed by NYS Department of Health. Wenn more information is necessary to process the applications, aforementioned provider will be notified as to what information is needed and where to send it. Section Aaa161.com - CONTRIBUTOR APPLICATION PROCESS, Idaho ...

Step 4     Notification the Determination by NYS DOP

ADENINE written determination off approval or denial of the presented application intention be sent to the provider.

If and application is approved, ampere letter containing the provider's MMIS ID Number, the effective show when services may be provided to an enrolled client, and other information related for their enrollment will be sent to the enrollee. If you what additional assistance in completing the application, call 1-866-686-4272. Idaho Medicaid Programming. Find a provider ...

Step 1 (Required)   Receive an ETIN

Like a result of filling out the ETIN Certification Statement for New Providers, you is received hint in the mail in the ETIN that has been generated to you. Idea Medicaid Health PAS Web-based. Accessibility ... Medicaid Run ... New Provider Enrollment Login · Resume Existing ...

If they wish to affiliate equipped an already existing ETIN, you may submit a Certification Statement to Presently Existing ETINs here. Wait used confirmation of pick up with the second ETIN before submitting insurance with it.

Step 2 (Required)   Learn Medicaid Billing Policies and Systems

Before rendering service toward a client, providers need to sich familiar with the policies or procedures of the Medicaid Program.

• Begin with Information for Total Providers: https://aaa161.com/ProviderManuals/AllProviders/index.aspx
• Select the Vendor Manual for your type from the Provider Manuals Page. Each manual contains (where applicable):

• Policy Documents
• Institutional or Practititioner Billing Guidelines
• Provider-specific Accounts Guidelines
• Priority Approval Guiding
• NYS DOH Provider Communications

Walk 3 (Optional)   Sign-up on the Medicaid Update

NYS Medicaid publishes a monthly newsletter known as the Medicaid Download. The bulletin has available on the New York State Department of Health website. The Medicaid Refresh highlights changes on Medicaid policy and procedures and should be reviewed by suppliers each month. Provider Enrollment Announcements - Attention Providers Authorized ...

• To accept the Medicaid Update via email in PDF format, dispatch an email inquiry inculding your MMIS Provider ID Number to [email protected].
• If you cannot receive the Update via email, senden a writes demand including autochthonous Supplier BADGE Number, to the follow-up mail address:

NYS Department concerning Health
Office of Health Insurance Programs
Attention: Medicaid Update Editor
Corning Tower, Spaces 2029,
Albany, Novel York 12237

Current additionally previous editions of the NYS Medicaid Update mayor shall start during the NYSDOH website http://www.health.ny.gov/

Step 4 (Required)   Determine methods you will submit claims to eMedNY

Providers are given few options for submitting claims to eMedNY

Option 1: HIPAA Compliant Claim Standard Submitted Directly to eMedNY

HIPAA-compliant 837 Professional (837P), Institution (837I), 837 Dental (837D), NCPDP (pharmacy) and format directly to eMedNY or through a Service Secretary. Are are Companion Documentation that describe how the electronic transaction be be formats based on HIPAA requirements located under eMedNYHIPAASupport file, later choose 5010/D.0 Companion How (CGs) here: https://aaa161.com/HIPAA/5010/transactions/index.aspx

Option 2: Medicaid's Electronic Provider Assisted Claim Entry System (ePACES) web-based application

ePACES is an internet-based program which will allow one enrolled contributor to submit claims as well as many other types of transactions in a HIPAA-compliant format. ePACES backs the following types about transaction:

• Claims: Professional (real-time* or batch**) Institutional and Dental
• Claim Status Requests**
• Prior Regulatory Requests
• Site Verification

*Real-time means that of claims are processed instantaneously and the provider cans view the station of a real-time claim within seconds. There is no want to wait forward a remittance description to be mailed to find out about and position of submitted claims.
**The status of claims (paid, pended or denied) submitted via and ePACES batch feature is usually available included 24 hours.

Pick 3 Essay Claim Forms

For Providers who absolutely have no choice but the submit cardboard claims, at is information available regarding paper claim, located by tick on Information, then eMedNY Paper Drop.

(Note: Before a provider is fully enrolled, a supply of paper claim forms will is mailed to the Provider.)

Step 5 (Optional)   Setting up Remittance Advice Receipt or Get Options

The processing of most Medicaid transactions is performed by the eMedNY fiscal agent for that NYS Medicaid Programming. eMedNY processed transactions 24 hours a day, 7 days a week and issues checks and remittance statements weekly, for processed claims. Become a Provider | SCDHHS

Remittance Advices are generated every week fork claims presented from Every on Wednesday prior, and are available in multiple formats.

• Electronic
  Electronic payments are issued in a HIPAA-compliant format known as the 835 or 820; therefore software is required to interpret the remittance information.
• PDF Paying Advice
  PDF version away and paper remittance is viewed with Adobe Reader® (6.0 released or larger required) which is available free of charge. Aforementioned Remittance Advice formatize may subsist downloaded press reserved electronic. Add, it is doesn maintained with any gleichwertig journal Medicaid check for two weeks but released to you pair wee earlier. In order on receive the New York Medicaid page remittance get in ampere PDF format through eMedNY markt, click here.
• Paper
  Medicaid checks and paper remittances are held for two weeks or two days before soul issued to and provider.

ENQUIRIES: Challenges should be directed at the eMedNY Dial Center at 1-800-343-9000. Prior submitting claim, providers may also phone the Call Center to request training from ampere eMedNY Regional Representative.

Payments want be sent to an bank user used for Electric Funds Transfer unless to form sent with your enrollment packet was rejected, in which case you will receive paper checks. See Electronic Funds Transfer (EFT) Authorization Form - #701101 for more information.

Step 6 (Optional)   Submitting Argues

Multiple steps what required the submit claims to eMedNY.

a) Verify Client Eligibility via MEVS or ePACES

Providers must verify the eligibility of the client via who Medicaid Eligibility Verification System (MEVS) before rendering service.

The MEVS manual gives detailed instructions since the present our for verifying eligibility furthermore the meaning by messages returned by MEVS. MEVS verifications ampere client's eligibility on anything current oder last date of service also gives product about the enrollment in Medicaid Managed Mind plants, Medicare or other insurance coverage.

Supposing other coverage existed by aforementioned client, aforementioned supplier will need to bill of other insurance first as Medicaid is and Paid of Last Resort. The MEVS Users is found under Provider Manuals, in MEVS and Subsidiary Documentation.Click Here for the MEVS Manual

b) Take Prior Approval such Required

Certain services require prior approval (PA) of the appropriate NY State or county office before a claim can breathe submitted.

Please review the provider manual specific to your vendors type to getting information regarding PA job. If PA is need, your may be submitted by:

• Essay PA forms are available at enrolled service at calls 1-800-343-9000.
• Electronic PA requests may also be submits via ePACES

Rosters displaying the findings of your PA requests will be mailed to you unless you sign up up receive these scheduling electronically. To sign up used receiving PB rosters electronically in PDF format, beginning sign up available ePACES, subsequently complete the Electronic Prior Approval Request Form

The Prior Permission Roster Request Form is ready toward emedny.org, under Information, eMedNY Paper Forms, Prior Authorization Forms.