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The document is a New York State Medicaid Enrollment Form for providers wishing to enroll in the Medicaid Program. It outlines the requirements for enrollment, including compliance with state regulations, the necessity of providing personal and business information, and the implications of rendering services before completing enrollment. The form also includes sections for disclosing ownership and control interests, as well as questions regarding prior conduct related to Medicaid or other insurance programs. Providers must sign the form to affirm their understanding and agreement to comply with all relevant laws and regulations.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (135 Votes)
2015	4.4 Satisfied (45 Votes)
2014	4 Satisfied (29 Votes)

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Does NY Medicaid accept paper claims?

Claims Submission Professional service providers may submit their claims to NYS Medicaid using electronic or paper formats.

What is the purpose of MMIS?

The MMI is designed to assess communication skills, specifically verbal and nonverbal skills that cannot be measured by standardized exams or transcripts. The MMI typically consists of six to 10 very short interviews that revolve around a specific scenario.

How do I check my Medicaid status in NY?

Call the HRA Medicaid Helpline at 888-692-6116 for more information. During the COVID-19 Emergency, applications may be submitted via fax to 917-639-0732.

Where do I mail my NYS Medicaid claim?

Correspondence should be mailed to the following address, with the applicable P.O. Box from the table below: eMedNY P.O. Box Rensselaer, New York 12144- . The list of diagnosis codes is also available through publishing houses. 2.

How do I enroll in NYS Medicaid as a provider?

Step 1 (Required Unless Exempt) Obtain an National Provider ID (NPI) Step 2 (Required) Submit an Enrollment Application for Your Provider Type. Step 3 Application Review by NYS DOH. Step 4 Notification of Determination by NYS DOH. Step 1 (Required) Receive an ETIN.

How do I file a Medicaid claim in NY?

Call the HRA Medicaid Helpline at 1-888-692-6116 for more information or visit a Medicaid Office to apply. During the COVID-19 Emergency, applications may be submitted via fax to 917-639-0732.

How do I find my NY Medicaid ID number?

If you arent sure what your Medicaid ID number is, you can get this information from Health and Human services either in-person or over the phone by providing them with your identifying information along with a photo ID.

What is a payer ID?

The Payer ID or EDI is a unique ID assigned to each insurance company. It allows provider and payer systems to talk to one another to verify eligibility, benefits and submit claims. The payer ID is generally five (5) characters but it may be longer.

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