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How to submit a claim to medicaid ny

New york billing medicaid 2026

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The document outlines the New York State Medicaid General Billing Guidelines for professional service providers, detailing the procedures for submitting claims electronically or via paper forms. It includes instructions on completing the eMedNY-150003 claim form, requirements for certification statements, and guidelines for billing Medicare crossover claims. Additionally, it provides specific instructions for various fields on the claim form, including patient information, procedure codes, and necessary consent forms for sterilization and hysterectomy procedures. The document serves as a comprehensive reference to ensure compliance with NYS Medicaid billing requirements.

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Click ‘Get Form’ to open the New York Billing Medicaid form in the editor.
Begin with the Header Section (Fields 1-23B). Enter the patient's name, date of birth, and Medicaid number. Ensure all entries are legible and correctly formatted.
In the Claims Submission section, choose between electronic or paper claims. If using paper, ensure you have a valid ETIN and Certification Statement.
Complete the Procedure Section (Fields 24A-24O) by entering service dates, procedure codes, and charges. Make sure to follow guidelines for modifiers and diagnosis codes.
Finally, sign the form in Field 25 and provide your NPI number. Review all fields for accuracy before submission.

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emedny 150003 claim form

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