July 2009    Volume 25, Number 9  

New York State Medicaid Update

The official newsletter of the New York Medicaid Program

David A. Paterson, Governor
State of New York

Richard F. Daines, M.D. Commissioner
New York State Department of Health

Deborah Bachrach, Deputy Commissioner
Office of Health Insurance Programs

Welcome to the July 2009 edition of the Medicaid Update. This month's newsletter includes a series of bulletins to help keep your office running efficiently. Take a peek inside to learn more about these important billing and policy updates. Please remember to notify us if your contact information changes. Please e-mail your updated information to: medicaidupdate@health.state.ny.us

In this issue....

A New Access Method is Now Available for Transmitting and Receiving Files with EMEDNY Via the Internet
DOH and OMH Partnering to Improve Psychotropic Prescribing In New York State
Transportation Billing for Multiple Dates of Service
Medicaid Reimbursement for Office Based Surgery
New York Announces Mandatory Compliance Programs for Providers Participating in Medicaid
Medicaid and Family Health Plus Prescribers:
Get Ready for New York Medicaid's E-Prescribing Incentive Program
Smoking Cessation Advertisement
Provider Services

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Computer Sciences Corporation (CSC) has implemented a new communication method to allow Medicaid trading partners to submit files via the internet. The new method is for users who prefer to develop an automated systemic approach for submitting files using the internet as a communication mechanism. CSC will be phasing out the current dial-up Bulletin Board System (BBS) in the near future and is currently urging trading partners to switch to a different method of file submission. To learn more about the new internet-based communication method please contact the eMedNY Call Center at (800) 343-9000 or via e-mail to: eMedNYProviderServices@csc.com

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The New York State Office of Mental Health (OMH) is partnering with the Department of Health (DOH) on a Continuous Quality Improvement initiative. The project's central vehicle is the Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES), an award-winning Web-based computer program that provides access to treatment histories housed in Medicaid claims databases. Reports generated from PSYCKES provide a list of quality indicators, with a current focus on psychotropic polypharmacy and cardiometabolic conditions based on recommendations by the project's Scientific Advisory Committee, a group of national experts in psychotropic prescribing practices. Research has shown that people with serious mental illness experience higher rates of cardiometabolic risk factors, higher rates of illness, and worse outcomes for major medical conditions. Second generation antipsychotics (SGAs) contribute to psychotropic polypharmacy regimens, and certain SGAs-some more than others-have been associated with raising cardiometabolic risk.

Three Web-based CME courses have been developed to help educate clinicians about new research findings. These courses cover psychotropic polypharmacy, as well as cardiometabolic risk in youth and adults. Additional resources will also be available to providers, including clinical consultations, Grand Rounds, and clinical training and educational opportunities. These courses can be accessed at: http://nyhealth.gov/health_care/medicaid/program/prescriber_education/presc-educationprog.

For more information about the projects supported by the DOH-OMH partnership or to access the CMEs please visit: https://psyckesmedicaid.omh.state.ny.us.

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Transportation billing is date-specific for each date of service a provider transports a beneficiary. A separate claim line should be submitted as illustrated in the example below:

  • Example: Mrs. Jones was transported round trip on July 1, 2, and 3. A separate claim line should be submitted for each of these three dates of service.

Additionally, claim edit 700 (PA Units or Payment Amount Exceeded) will deny claims which contain more daily units than allowed by a prior authorization. For more information on submitting claims, please consult the Billing Guidelines Manual at: http://www.emedny.org/ProviderManuals/Transportation/index.html

Computer Sciences Corporation (CSC) provides billing training upon provider request. To schedule a training or if you have billing questions, please contact CSC at (800) 343-9000. Policy questions? Please contact Medicaid Transportation policy staff at (518) 408-4825 or e-mail MedTrans@health.state.ny.us.

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Effective July 14, 2009, New York State law (Chapter 365 of the Laws of 2007) requires accreditation of physician offices where surgical or other invasive procedures are performed under moderate sedation, deep sedation or general anesthesia. Additionally, the law requires that physicians, physician assistants and specialist assistants report specific adverse events that occur in relation to office based surgery to the Patient Safety Center of the Department of Health.

The law stated above does not apply to dentists or podiatrists. The State Education Department has issued specific guidelines which apply to dentists and podiatrists:

Please visit the following links:

If you have further questions related to OBS, please contact the Patient Safety Center at obs@health.state.ny.us. For further questions on Medicaid and OBS, please contact Fee for Service Provider Enrollment at (518) 402-7032.

Please visit http://www.health.state.ny.us/professionals/office-based_surgery. This link will provide additional details related to the Office Based Surgery (OBS) Law along with the following:

  • Designated Accrediting Agencies
  • Links to the Public Health Law
  • Surgical and invasive procedure protocols
  • Reporting Requirements
  • Frequently Asked Questions

Beginning with the date of service of July 14, 2009, Medicaid will no longer pay for office based surgery or other invasive procedures performed under moderate sedation, deep sedation or general anesthesia unless the office location has been accredited by one of the designated accrediting agencies. To avoid claim denials, physicians and groups who perform OBS in accredited sites must fax or mail a copy of the accreditation and a list of all physicians who are associated with each accredited site to:


Fee for Service Provider Enrollment
Office Based Surgery Documentation
150 Broadway, Suite 6E, Albany, NY 12204
Fax Number: (518) 473-7251


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Proposed regulation 18 NYCRR Part 521 - Provider Compliance Programs was adopted and took effect on July 1, 2009. This regulation was created to implement the requirements set forth in Social Services Law 363-d (SSL 363-d). In ratifying SSL 363-d, the Legislature found that Medicaid providers may be able to detect and correct payment and billing mistakes and fraud if required to develop and implement compliance programs. The regulation will require certain providers to adopt and implement effective compliance programs. Providers subject to this regulation are all providers subject to Articles 28 and 36 of the Public Health Law; all providers subject to Articles 16 and 31 of the Mental Hygiene Law; and all providers who order services or supplies, or receive reimbursement, directly or indirectly, or submit claims, for at least $500,000 annually.

As part of the regulation, providers will be required to certify annually, and every December thereafter, that they have satisfactorily met the requirements of the statute. Providers will have 90 days to comply after the July 1, 2009 effective date. New York is the first state to make provider compliance programs mandatory. Mandatory compliance programs will be a significant tool in reducing fraud, waste and abuse in New York's Medicaid program. SSL 363-d also requires the OMIG to create, and make available on its Website, guidelines, which reflect the requirements of the statute. The OMIG will be issuing provider-specific compliance program guidance that will outline recommendations regarding how specific segments of the provider industry are able to implement a compliance program.

The text of the regulation is available on the OMIG's Website. The compliance program guidance, when issued, will also be available on the OMIG's Website http://www.omig.state.ny.us.

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Important reminders about the New York State Medicaid Pharmacy Prior Authorization Program Clinical Call Center.

When calling for a prior authorization, Clinical Call Center Representatives can provide the following information:

  • Provider enrollment and license status
  • Eligibility information for a date of service
  • Prior authorization status
  • Prior authorization number (including rendered units and refill numbers)
  • Pricing information (you will be referred to eMedNY Call Center (CSC) at 800-343-9000)


Clinical Call Center Representatives cannot provide the following information:

  • Provider NPI numbers
  • Beginning and end dates of member eligibility
  • Date of birth or sex of a Medicaid enrollee
  • Client card sequence number
  • Claims information
  • The last date of payment on a prior approval
  • NDC number
  • Specifics regarding services enrollees may be receiving through other providers

For clinical concerns or Preferred Drug Program questions, contact (877) 309-9493. For billing questions, contact (800) 343-9000. For Medicaid pharmacy policy and operations questions, contact (518) 486-3209.

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Prescription Origin Codes

0 = Not Specified
1 = Written
2 = Telephone
3 = Electronic
4 = Facsimile

In preparation for New York State's Medicaid e-prescribing incentive program, effective January 1, 2010, all Medicaid pharmacy claims for electronic prescriptions must include the number "3" in the NCPDPPrescription Origin Code (Field 419-DJ). To qualify as an electronic prescription, the electronic transaction must conform, at a minimum, to Medicare Part D standards and requirements (1). New York is following the lead of the HHS Centers for Medicare and Medicaid Services (CMS), who will require the use of this field for all Medicare Part D claims effective January 1, 2010.

Although New York is initially only requiring use of the field for e-prescriptions, it is the State's intent to mandate use of the Prescription Origin Code for all Medicaid prescription claims effective July 1, 2010. After July 1, 2010, pharmacy claims that do not have an entry in this field will be denied. Pharmacies are encouraged to consult with their software vendors to facilitate auto-population of this field. The NCPDP allowable entries are outlined in the box above.

(1) Centers for Medicare and Medicaid Services. Medicare Program; Standards for E-Prescribing Under Medicare Part D and Identification of Backward Compatible Version of Adopted Standard for E-Prescribing and the Medicare Prescription Drug Program. (Version 8.1); Final Rule. Federal Register. Volume 73, No. 67, April 7, 2008, pp. 18918 - 18942.

Smoking Cessation
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No Smoking

By providing counseling, pharmacotherapy, and referrals, you can double your patients' chances of successfully quitting.
For more information, visit http://www.talktoyourpatients.org or call the NY State Smokers' Quitline at 1-866-NY-QUITS (1-866-697-8487).

Do you suspect that a Medicaid provider or an enrollee has engaged in fraudulent activities?
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Call: 1-877-87FRAUD or (212 417-4570)

Your call will remain confidential.

You can also complete a Complaint Form online at:



Quick Reference Guide
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Office of the Medicaid Inspector General:
http://www.omig.state.ny.us or call (518) 473-3782 with general inquiries or 1-877-87FRAUD with suspected fraud complaints or allegations.

Questions about an Article?
Each article contains a contact number for further information, questions or comments.

Questions about billing and performing EMEVS transactions?
Please contact eMedNY Call Center at: (800) 343-9000.

Provider Training
To sign up for a provider seminar in your area, please enroll online at:

For individual training requests, call (800) 343-9000 or email: emednyproviderrelations@csc.com

Enrollee Eligibility
Call the Touchtone Telephone Verification System at any of the numbers below:

(800) 997-1111    (800) 225-3040      (800) 394-1234.

Address Change?
Questions should be directed to the eMedNY Call Center at: (800) 343-9000.

Fee-for-Service Providers
A change of address form is available at: http://www.emedny.org/info/ProviderEnrollment/index.html

Rate-Based/Institutional Providers
A change of address form is available at: http://www.emedny.org/info/ProviderEnrollment/index.html

Comments and Suggestions Regarding This Publication?
Please contact the editor, Kelli Kudlack, at: medicaidupdate@health.state.ny.us

Medicaid Update is a monthly publication of the New York State Department of Health containing information regarding the care of those enrolled in the Medicaid Program.