Attention Medicaid Managed Care/CHIP Program Providers: You Must Enroll in the Medicaid Program Effective 01/01/2018

Effective January 1, 2018, federal law requires that all Medicaid Managed Care Network providers, as well as all Children’s Health Insurance Program providers, enroll with state Medicaid programs.  For example, this applies to a provider that currently participates in a network with a New York State Medicaid managed care plan that provides services to, or orders, prescribes, or certifies eligibility for services for Medicaid-eligible individuals.  The mandated enrollment must include “providing identifying information including name, specialty, date of birth, social security number, National Provider Identifier (NPI), federal taxpayer identification number, and the state license or certification number.”

The May 2017 Update provided the following information on “common enrollment questions”:

To check on your enrollment status, you may check the Enrolled Practitioners Search function at https://www.emedny.org/info/opra.aspx.

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 (you are no longer actively enrolled), you may be able to keep your original Provider Identification Number (PID), also known as MMIS ID, by requesting reinstatement.

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.

If you are not actively enrolled, go to: https://www.emedny.org/info/ProviderEnrollment/index.aspx. Once there you will need to navigate to your provider type, then print the Instructions and the Enrollment form. At this website, you will also find a Provider Enrollment Guide, a How Do I Do It? Resource Guide, FAQs.  The website all provides all necessary enrollment forms in New York State Medicaid.

This article was written by David R. Ross who is a Shareholder of the firm. Prior to joining the firm, and under former Governors Pataki and Spitzer, Mr. Ross served as the Acting Medicaid Inspector General for New York State. He also served as General Counsel, Deputy Medicaid Inspector General and Director of Audits and Investigations for the Office of the Medicaid Inspector General. Prior to his service at the Office of the Medicaid Inspector General, Mr. Ross held several positions at the New York State Office of Alcoholism and Substance Abuse Services (OASAS), including Acting General Counsel, Deputy Counsel, and Associate Counsel. Mr. Ross also handles Medicaid compliance matters of all kinds, as well as both Medicare and Medicaid audits and investigations for providers of all types and sizes. He can be reached at (518) 462-5601 or via e-mail at dross@oalaw.com.


David Ross

About David Ross

David is Partner and concentrates his practice on Medicaid, Medicare and private insurance audits & investigations, Health Law including fraud and abuse, governmental investigations of all kinds, Medicaid compliance plans and Article 78 cases. He is head of our Government Investigations practice and also works in Healthcare Fraud & Abuse.