What's New

The following manual has been updated on the ProDUR-ECCA D.0 Provider Manual page for PHARMACY providers:

• ProDUR-ECCA D.0 Provider Manual

The following Provider Manuals have been updated/added for RESIDENTIAL HEALTH providers:

• Request for Prior Approval - Initial Admission to an Out-of-State Skilled Nursing Facility Form
• Renewal Request for Out-of-State Skilled Nursing Facility Form
• Initial Admission Request to an Out-of-State Skilled Nursing Facility (SNF) FAQ

Two New Provider Communications have been posted for MIDWIFE, PHYSICIAN, PODIATRY, NURSE PRACTITIONER, ORDERED AMBULATORY and PHARMACY providers:

• NYRx Allows 90 Day Prescribing
• NYRx 90 Day Supply Fact Sheet

The following manual has been updated for all providers:

• Information for All Providers - Inquiry

The PROCEDURE CODES have been updated for the following provider:

• Physician: Medicine and Drugs

The following manual has been updated for PHARMACY providers:

• Policy Guidelines

A New Provider Communication has been posted for MIDWIFE, PHYSICIAN, PODIATRY, NURSE PRACTITIONER and ORDERED AMBULATORY providers:

• Upcoming Changes to Billing Requirements for Medicaid Fee-for-Service Professional Drug Claims

The FEE SCHEDULE has been updated for the following provider:

• Transportation

A New Provider Communication has been posted for DENTAL providers:

• Reminder to Dental Providers: Fee-For-Service Dental Claim Submission Guidance when Third-Party Liability (TPL) Payment is Involved

The following manual has been updated for Dental, DME, Hearing Aid, Physician, Private Duty Nursing and Vision Care providers:

• Prior Approval Business Location Chart

The following manual has been updated for PRIVATE DUTY NURSING providers:

• Policy Guidelines

A New Provider Communication has been posted for PHARMACY providers:

• Reminder: Pharmacy Providers Regarding Member Out-of-Pocket Costs

A New Provider Communication has been posted for DENTAL providers:

• Enrolled Dental Provider Survey

A New Provider Communication has been posted for PHARMACY providers:

• Important Communication: Unlicensed Interns, Residents & Foreign Physicians in Training Programs are Authorized Prescribers for Medicaid Members

A New Provider Communication has been posted for PHARMACY providers:

• NYRx BLTG Program Update

The PROCEDURE CODES have been updated for the following providers:

• Midwife
• Nurse Practitioner
• Physician: Medicine and Drugs
• Physician: Surgery

The following Provider Communication has been posted for PHARMACY providers:

• NYRx Medicaid Pharmacy Prior Authorization Programs Update

The following Provider Communication has been posted for PHARMACY providers:

• Pharmacy Reminder: SMAC Price Research Requests and NYRx Reimbursement

The following Provider Communication has been posted for PHARMACY providers:

• Illegal Oral Prescriptions

The following Provider Communication has been posted for PHARMACY providers:

• Reminder: Coordination of Benefits (COB) - Processing with Other Payer ID and Other Payer ID Qualifier for Pharmacy Claims

The following Provider Communication has been posted for PHARMACY providers:

• Pharmacy Providers: Severe Weather Events

The following Provider Manual has been updated for DOULA providers:

• Policy Guidelines

The FEE SCHEDULE has been updated for the following provider:

• Transportation

A New Provider Communication has been posted for DME and PHARMACY providers:

• Updated Durable Medical Equipment, Orthotics, Prosthetics and Supplies (DMEPOS) Fiscal Order Acceptance Policy

The following manual has been added for DME and PHARMACY providers:

• Update to Coverage and Billing of Continuous Glucose Monitors and Related Supplies in the Preferred Diabetic Supply Program

Two Provider Communications have been posted for PHARMACY providers:

• Top Edit Resource
• COVID-19 Guidance for Medicaid Providers

The following manual has been updated for DOULA providers:

• Fee Schedule

A New Provider Communication has been posted for PHARMACY providers:

• New York State Medicaid Billing Guidelines for Administering Mental Health or Substance Abuse Treatment Injections at the Pharmacy

The following manual has been updated for TRANSPORTATION providers:

• Contact List

A New Provider Communication has been posted for PHARMACY providers:

• New York State Medicaid (NYRx) Coverage Policy and Billing Guidance for Pharmacist Dispensing of Self-Administered Hormonal Contraception

The PROCEDURE CODES have been updated for the following providers:

• Clinical Psychology
• Midwife
• Nurse Practitioner
• Ordered Ambulatory
• Physician: Medicine and Drugs
• Physician: Anesthesia
• Physician: Surgery
• Physician: Radiology
• Podiatry
• Rehabilitation Services
• Vision Care

A New Provider Communication has been posted for PHARMACY providers:

• New York State Medicaid (NYRx) Coverage Policy and Billing Guidance for Pharmacist Ordering and Dispensing of Self-Administered Hormonal Contraception

The following manual has been updated for DOULA providers:

• Fee Schedule

The following manual has been added for DME and PHARMACY providers:

• Medical Supply Procedure Codes & Coverage Guidelines

A New Provider Communication has been posted for Clinic, Dental, Managed Care and Physician providers:

• NYS Medicaid Dental Policies - All Stakeholder Webinar Frequently Asked Questions (FAQ)

The following manual has been updated for MIDWIFE providers:

• Policy Guidelines

A New Provider Communication has been posted for DME providers:

• Enteral Product Classification List 2024

The following manuals have been updated for LABORATORY providers:

• Procedure Codes
• Fee Schedule

The following manual has been updated for PHARMACY providers:

• Medical Supply Codes

The following manual has been updated for HOSPICE providers:

• Policy Guidelines

The following manual has been updated for Community Health Worker Service providers:

• Policy Guidelines
• Procedure Codes & Fee Schedule

The following manual has been updated for ABA providers:

• Policy Guidelines

The following document has been updated:

Information for All Providers - Managed Care Information

The following manuals have been updated for DENTAL providers:

• Fee Schedule
• Policy and Procedure Code Manual

The following manual has been updated for ORDERED AMBULATORY providers:

• Fee Schedule

A New Provider Communication has been posted for DENTAL providers:

• January 2nd Webinar Slides on the New NYS Dental Policies

A New Provider Communication has been posted for PHARMACY providers:

• NYRx BLTG Program Update: Flovent and Advair