The following manual has been updated for PHARMACY providers:

• Policy Guidelines

A New Provider Communication has been posted for PHARMACY providers:

• UPDATE: Medicaid Coverage for the 2023-2024 COVID-19 Vaccines for Pharmacy Providers Not Enrolled in the Vaccines for Children (VFC) Program

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 DME and PHARMACY providers:

• Addition of Parenteral Nutrition HCPCS B4187

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

• Medicaid Practitioner Administered Drugs Update

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

• Enteral Nutrition Pricing Increase

A New Provider Communication has been posted for Private Duty Nursing (PDN) providers:

• Electronic Visit Verification (EVV) Update for PDN Providers

A New Provider Communication has been posted for DENTAL providers:

• Clinical Criteria Guidance to Updated Dental Medicaid Dental Benefits Effective 1/31/2024

A New Provider Communication has been posted for PHARMACY providers:

• UPDATE: Long-Term Care Pharmacies New Patient and Leave of Absence

A New Provider Communication has been posted for DME providers:

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

A New Provider Type has been added: Community Health Worker Services (CHW).

The following NEW Provider Manuals has been posted:

• CHW Policy Guidelines
• CHW Procedure Codes & Fee Schedule

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

• Importance of Medical Coding on Practitioner Drug Claims

A New Provider Communication has been posted for DME providers:

• Update Regarding Accu-Chek® Guide Test Strips compatible with MiniMed (Medtronics) Insulin Delivery System, HCPCS A4253

A New Provider Communication has been posted for PHARMACY providers:

• NYRx BLTG Program Update

The following Provider Manual has been updated for DENTAL providers:

• Fee Schedule

The FEE SCHEDULES have been updated for the following providers:

• Midwife
• Nurse Practitioner
• Ordered Ambulatory
• Physician: Drugs
• Physician: Medicine

The following Provider Manual has been updated for Licensed Clinical Social Workers (LCSW) providers:

• Billing Guidelines

A New Provider Communication has been posted for PHARMACY providers:

• NYS Medicaid Billing Guidance on Adult RSV Vaccines

A New Provider Communication has been posted for PHARMACY providers:

• Pharmacists as Immunizers Fact Sheet

The following Provider Manual has been updated for DOULA providers:

• Policy Guidelines

A new guide has been added under ePACES Reference Sheets:

• ePACES - Out Of State Skilled Nursing Facility PA Requests/Responses

The FEE SCHEDULES have been updated for the following providers:

• Midwife
• Nurse Practitioner
• Ordered Ambulatory
• Pharmacy
• Physician: Drugs

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

• Policy Guidelines
• Out-of-State Skilled Nursing Facility Policy Guidelines
• Request for Prior Approval - Initial Admission to an Out-of-State Skilled Nursing Facility Form
• Renewal Request for Out-of-State Skilled Nursing Facility

The following Provider Manual has been updated for PHYSICIAN providers:

• Policy Guidelines

The following Provider Manual has been updated for PHARMACY providers:

• Fee Schedule

A New Provider Communication has been posted for PHARMACY providers:

• NYRx Medicaid Providers Dispense Brand Name Drug when Less Expensive than Generic Program

A New Provider Communication has been posted for PHARMACY providers:

• Medicaid Drug Rebate Program Updates for July 1st, 2023

The FEE SCHEDULE has been updated for the following provider:

• DME

A New Provider Communication has been posted for INPATIENT providers:

• Referral Form for Prior Approval - OOS Medical Treatment

A New Provider Communication has been posted for PHARMACY providers:

• Important Information: Coordination of Benefit (COB) Reversals with Other Coverage Code (OCC) value "4"

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

• Enteral Product Classification List 2023

Two (2) New Provider Communications have been posted for PHARMACY providers:

• 30-Day Countdown - NYRx Transition Fill Period Ending
• Important Information Regarding Electronic Claims Capture and Adjudication (ECCA) for Pharmacy Providers

The PROCEDURE CODES have been updated for the following providers:

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

The following Provider Manual has been updated for PHARMACY providers:

• Policy Guidelines

The following resource document has been updated for the Pharmacy Benefit Transition (NYRx) program:

• Top Edit Resource

The following Provider Manuals have been updated for LABORATORY providers:

• Procedure Codes
• Fee Schedule

A New Provider Communication has been posted for PHARMACY providers:

• Coordination of Benefits & Workers Compensation Coverage

A New Provider Communication has been posted for DME providers:

• Information for Physicians and other Practitioners who prescribe Enteral Products for Medicaid Members, including Members affected by the Managed Care NYRx/ Fee for Service Transition

The following Provider Manual has been updated for HOSPICE providers:

• Policy Guidelines

The following Provider Manual has been updated for OMH Certified Rehabilitation Services providers:

• OMH Certified Rehabilitation Services Billing Guidelines

The following Provider Manual has been updated for DOULA providers:

• Policy Guidelines

The following Provider Manual has been updated for PHARMACY providers:

• Medical Supply Codes

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

• Information for DMEPOS Providers and Pharmacies dispensing Medical Supplies for Members affected by the Managed Care NYRx/ Fee for Service Benefit Transition beginning April 1, 2023

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 Manual has been updated for PHARMACY providers:

• Medical Supply Codes

The following Manual has been updated for Applied Behavior Analysis (ABA) providers:

• Policy Guidelines
  
  

Two (2) NEW Provider Communications have been posted for: CLINIC, MIDWIFE, NURSE PRACTITIONER, PHYSICIAN, and PODIATRY providers:

• Medicaid Pharmacy Prior Authorization Programs Update
• Medicaid Practitioner Administration Drugs Update

The following manual has been updated for PHARMACY providers:

• Policy Guidelines

A New Provider Communication has been posted for PHARMACY providers:

• NYRx BLTG Program Update

The following document has been updated for Medicaid Managed Care Network (MMCN) providers:

• NYS Enrollable Providers

The following Provider Manuals have been updated for Private Duty Nursing providers:

• Policy Guidelines
• Procedure Codes
• Billing Guidelines

A New Provider Communication has been posted for PHARMACY providers:

• Clarification for Long-Term Care Pharmacies New Patient and Leave of Absence

Two New Provider Communications have been posted for DENTAL providers:

• Revisions Table
• 2023 NYS Medicaid Dental Policy and Procedure Code Manual and Updated Fee Schedule

A New Provider Communication has been posted for DME providers:

• Practitioners Ordering Incontinence Products

The FEE SCHEDULE has been updated for the following provider:

• Transportation

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 FEE SCHEDULE has been updated for the following provider:

• Pharmacy

The Policy Guidelines has been updated for the following provider:

• Clinic

The FEE SCHEDULES have been updated for the following providers:

• Podiatry
• Vision Care

The Procedure Codes and Fee Schedule has been updated for the following providers:

• Licensed Mental Health Counselor (LMHC) & Licensed Marriage and Family Therapist (LMFT)
• Licensed Clinical Social Worker (LCSW)

The FEE SCHEDULES have been updated for the following providers:

• Ordered Ambulatory
• Physician: Radiology
• Pharmacy

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

• Correction - 2023 Coding Changes for Continuous Glucose Monitoring

The following manual has been updated for PHARMACY providers:

• Policy Guidelines

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

• ProDUR-ECCA D.0 Provider Manual