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HealthCare News

November 1, 2017

Attention Managed Care Network Providers! New York State now requires all Healthcare providers to enroll with Medicaid.

 

Effective January 1, 2018, Federal law requires that all Medicaid Managed Care and Children´s Health Insurance Program network providers to be enrolled with State Medicaid program.

Enrollment applications must be submitted to the Medicaid by December 1, 2017. Providers have less than 30 days to enroll with Medicaid otherwise, will lose their Managed Care contracts (such as Health First, Metroplus, Affinity, Fidelis, Amerigroup and etc.) as of new year.

  • To check on your enrollment status, please call Medicaid at 1–800–343–9000. Practitioners may also check the Enrolled Practitioners Search function at eMedNY
  • If you are already enrolled as a Medicaid fee–for–service (FFS) provider and are listed as active, you will not have to enroll again.
  • If at one time you were a FFS provider, and your enrollment has lapsed (no longer actively enrolled), you may be able to keep your original Provider Identification Number (PID), also known as MMIS ID, by reinstating.
  • Practitioners who do not wish to enroll as a Medicaid FFS billing provider may enroll as a non–billing, Ordering/Prescribing/Referring/Attending (OPRA) provider.
  • Enrollment in Medicaid FFS does not require providers to accept Medicaid FFS patients.

 

Frequently asked questions:

 

Medicaid enrolment, for some specialties, requires a Medicare provider ID. If a provider is not enrolled with Medicare yet, is this possible to avoid the requirement and get enrolled in Medicaid without billing privileges and without having the Medicare ID?

Answer provided by the WCH Credentialing Department Supervisor Anastasiya Yusupova

No, it is impossible to avoid Medicare enrollment, but Medicaid understands the situation and allows to submit applications simultaneously.

 

What to do if my specialty is not recognized by the Medicaid?

Answer provided by the WCH Credentialing Department Supervisor Anastasiya Yusupova

If the specialty is not recognized by the Medicaid, then the provider can ignore letters received from Medicaid Managed Care and Children´s Health insurance plans. Make sure that providers who refer or order services also maintain their Medicaid ID, as this will affect your claims.

 

For more information, please visit eMedNy or contact your account representative at WCH

 

 

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