Most providers must receive an NPI from the National Plan and Provider Enumeration System (NPPES).
A NYS Medicaid Enrollment Application must be submitted by prospective providers.
Go to the Provider Index page on this site. Each Provider enrollment form has:
Applications that are missing one or more requirements will be sent back to the enrollee for completion.
Complete applications will be reviewed by NYS Department of Health. If more information is necessary to process the application, the provider will be notified as to what information is needed and where to send it.
A written determination of approval or denial of the submitted application will be sent to the provider.
If the application is approved, a letter containing the provider's MMIS ID Number, the effective date when services may be provided to an enrolled client, and other information related to their enrollment will be sent to the enrollee.
How to Submit and be Paid for Services Rendered to Eligible Medicaid clientsAs a result of filling out the ETIN Certification Statement for New Providers, you will receive notice in the mail of the ETIN that has been generated for you.
If you wish to affiliate with an already existing ETIN, you may submit a Certification Statement for Currently Existing ETINs here. Wait for confirmation of set up with the second ETIN before submitting claims with it.
Before rendering service to a client, providers need to become familiar with the policies and procedures of the Medicaid Program.
NYS Medicaid publishes a monthly newsletter known as the Medicaid Update. The newsletter is available on the New York State Department of Health website. The Medicaid Update highlights changes to Medicaid policy and procedures and should be reviewed by providers each month.
NYS Department of Health
Office of Health Insurance Programs
Attention: Medicaid Update Editor
Corning Tower, Room 2029,
Albany, New York 12237
Current and previous issues of the NYS Medicaid Update may be found at the NYSDOH website http://www.health.ny.gov/
Providers are given several options for submitting claims to eMedNY
HIPAA-compliant 837 Professional (837P), Institutional (837I), 837 Dental (837D), NCPDP (pharmacy) and formats directly to eMedNY or through a Service Bureau. There are Companion Documents that describe how the electronic transaction must be formatted based on HIPAA requirements located under eMedNYHIPAASupport tab, then choose 5010/D.0 Companion Guides (CGs) here: https://www.emedny.org/HIPAA/5010/transactions/index.aspx
To enroll in ePACES: All you need to enroll in ePACES is a NYS Medicaid Provider ID number, an ETIN, and an internet address. Contact the eMedNY Call Center at 1-800-343-9000 to begin the enrollment process.
For Providers who absolutely have no choice but to submit paper claims, there is information available regarding paper claims, located by clicking on Information, then eMedNY Paper Forms.
(Note: Once a provider is fully enrolled, a supply of paper claim forms will be mailed to the Provider.)
The processing of most Medicaid transactions is performed by the eMedNY fiscal agent for the NYS Medicaid Program. eMedNY processes transactions 24 hours a day, 7 days a week and issues checks and remittance statements weekly, for processed claims.
Remittance Advices are generated every week for claims submitted from Thursday to Wednesday prior, and are available in multiple formats.
ENQUIRIES: Questions should be directed to the eMedNY Call Center at 1-800-343-9000. Before submitting claims, providers may also phone the Call Center to request training from a eMedNY Regional Representative.
Payments will be sent to the bank account used for Electronic Funds Transfer unless the 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.
Multiple steps are required to submit claims to eMedNY.
Providers must verify the eligibility of the client via the Medicaid Eligibility Verification System (MEVS) before rendering service.
The MEVS manual gives detailed instructions for the available methods for verifying eligibility and the meaning of messages returned by MEVS. MEVS verifies a client's eligibility for any current or past date of service and gives information about their enrollment in Medicaid Managed Care plans, Medicare or other insurance coverage.
If other coverage exists for the client, the provider will need to bill the other insurance first as Medicaid is the Payer of Last Resort. The MEVS Manual is found under Provider Manuals, in MEVS and Supplemental Documentation.Click Here for the MEVS Manual
Certain services require prior approval (PA) by the appropriate NY State or county office before a claim can be submitted.
Rosters showing the outcome of your PA requests will be mailed to you unless you sign up to receive these rosters electronically. To sign up for receiving PA rosters electronically in PDF format, first sign up for ePACES, then complete the Electronic Prior Approval Request Form
The Prior Approval Roster Request Form is available at emedny.org, under Information, eMedNY Paper Forms, Prior Authorization Forms.
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