Obtaining Payment Records

Medicaid regulations allow Medicaid Members to obtain copies of their Medicaid payment records directly or to authorize the release of their records to a third party, usually legal counsel. The Health Insurance Portability and Accountability Act (HIPAA) requires the Medicaid program to have an authorization from Members before releasing their protected health information for any purpose.

To establish that each release of health information was properly executed, the request with its authorization and accompanying documentation is retained by the Department of Health. As such, requests must be delivered to the address below: faxed or emailed requests are not accepted.

To have Medicaid payment records sent to a third party, please refer to the section below entitled Requesting the Release of Information to a Third Party.

To have Medicaid payment records sent directly to a Medicaid Member, to a Member´s Legal Guardian, to a minor Member´s parent, or to a deceased Member´s estate Administrator, please refer to the section below entitled Requesting the Release of Information to a Medicaid Member.

Any request to release Medicaid payment records to another party must consist of both a letter of request, either from the third party or from the Medicaid Member, and an authorization: Authorization to Release Protected Medicaid Member Information to a Third Party (DOH-5198) (PDF, 160KB).

The letter requesting Medicaid payment records must include:

  • the Medicaid Member´s name AND date of birth,
  • the Medicaid Member Client Identification (CIN) Number or Social Security Number, preferably both, and
  • the dates of service the report will cover.

A copy of the authorization form and the guidelines for submitting it can be found here: Authorization to Release Protected Medicaid Member Information to a Third Party (DOH-5198) (PDF, 160KB).

The following are requirements for an authorization to be considered valid:

  • The authorization must give the name and address of the party that the records will be sent to.
  • The authorization must be signed by the Medicaid Member or by a person having legal authority to sign for the Member. Except for the parent and natural guardian of a Medicaid Member who is a minor, persons signing on behalf of a Member must supply documentation proving their authority to act for the Medicaid Member.

A Medicaid Member´s Parent and Natural Guardian, Legal Guardian, estate Administrator, or Attorney-in-Fact may sign the authorization on the Member´s behalf.

  • Parents and Natural Guardians of minor Members require no supporting documentation but must sign, print their own name, and state they are signing as Mother and Natural Guardian (M/N/G), Father and Natural Guardian (F/N/G), or Parent and Natural Guardian (P/N/G).
  • Legal Guardians must provide a copy of the Letter of Guardianship. They must sign the authorization, print their own name, and state they are signing as Legal Guardian.
  • The Administrator of a deceased Member´s estate must provide a copy of the Letter of Administrator. They must sign the authorization, print their own name, and state they are signing as Administrator.
  • Attorneys-in-Fact must provide a copy of the Power of Attorney, which must be for the Member. They must sign the authorization, print their own name, and state they are signing as Attorney-in-Fact.
    • If the Member appoints an Attorney-in-Fact, the Member must sign the Power of Attorney.
    • If the Member´s authorized representative appoints an Attorney-in-Fact, the Power of Attorney must be for the Member and signed by the representative as Parent and Natural Guardian, Legal Guardian, Administrator, or Attorney-in-Fact. Legal Guardians, Administrators, and Attorneys-in-Fact must also provide a copy of their authorizing document, as detailed above.
    • If the Attorney-in-Fact is one or more individuals, one of those individuals must sign the authorization and print their own name.
    • If the Attorney-in-Fact is an organization, such as a law firm, the signer must sign and print their own name and state it is on behalf of the organization, as follows:
      • Chris Smith for Smith, Herrero, and Schmidt, PLLC

There must be an unbroken chain of authorization from the Medicaid Member to whomever signs on the Member´s behalf.

An authorization is not valid and will not be honored by the Office of Health Insurance Programs if any of the following apply:

  • The expiration date on the authorization has passed, or a year has passed since the authorization was signed.
  • The authorization contains whiteout, substitutions, or deletions that have not been initialed for approval by the signer.
  • The authorization has not been filled out completely.
  • The authorization bars release of certain information or requires NYSDOH to make redactions before release.
  • The authorization is known to have been revoked.
  • Any material information in the authorization is known by the covered program to be false.

Send the request to:

Medicaid Data Warehouse - CDRs
NYSDOH - MISCNY
ESP P1-11S Dock J
Albany NY 12237

Judicial subpoenas of Medicaid confidential data should be directed to:

Kerry-Ann N. Lawrence, Acting Director
Bureau of Litigation - Division of Legal Affairs
New York State Department of Health
Empire State Plaza - Corning Tower Building - Room 2438
Albany NY 12237

Allow time for approval and processing. Authorized requests normally generate a response within 30 days. Judicial subpoenas must be approved by the Division of Legal Affairs before processing and normally generate a response in 4-6 weeks.

The Bureau does not have the personnel or other resources to give status updates during the first 30 days of processing or to confirm deliveries. If you do not receive a response within 30 days of sending, you may call (518) 457-6323 for an update.

If you are a Medicaid Member, Federal regulations permit the release of Medicaid payment records directly to you. If you want to request this information, please complete the form, Member Request for Specific Protected Medicaid Health Information (DOH-5199) (PDF), and send it to the address on the bottom of the form:

Medicaid Data Warehouse - CDRs
NYSDOH - MISCNY
ESP P1-11S Dock J
Albany NY 12237

Please call (518) 457-6323 if you have any questions.