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Medicaid Provider Enrollment

The New York State Department of Health (DOH) is the single State agency responsible for the administration of the New York State Medicaid program. The DOH requires that chemical dependence entity/programs be certified by OASAS and in possession of an OASAS operating certificate before the program may apply for enrollment in the Medicaid program.

Upon approval, OASAS sends the provider an approval letter, an OASAS operating certificate, a Medicaid provider enrollment/application package and notification of the established Medicaid fee or rate for the newly certified service. OASAS also sends a copy of the OASAS operating certificate to the DOH.

Step 1: Complete the Medicaid provider enrollment/application package and submit it to the Computer Sciences Corporation, at P.O. Box 4603, Rensselaer, New York 12144. Any inquiries regarding the Medicaid provider enrollment application may be directed to (518) 474 - 8161.

Step 2: DOH and CSC review the Medicaid provider enrollment package. Upon approval, the DOH supplies the provider with the appropriate Medicaid billing codes, corresponding payment amounts, and effective date. Call the DOH, Office of Medicaid Management, for additional Medicaid provider enrollment/application information (518) 474- 8161.

Step 3: Providers complete the application for the National Provider Identification (NPI) number.

 

Timeline

After the Medicaid enrollment application is received and processed by CSC/DOH, the new provider will receive a letter which will note the assigned Medicaid provider number, locator codes, billing codes, rates or fees, and an effective date for their activation. The effective date will correspond with the effective date on the provider's OASAS operating certificate.

There will be a 6-8 week time lag between receipt of the operating certificate and assignment of the Medicaid provider number etc. If discrete Division of Budget rate approval is necessary, there may a longer than 6-8 week time lag. The new Medicaid provider will, however, be able to bill back to the effective Medicaid date of the provider's OASAS operating certificate.

Medicaid Billing Information

DOH has migrated portions of Medicaid manuals/guidance to the eMedNY information site. Newly enrolled providers should go visit eMedNY and download the appropriate manual type. Hardcopy manuals are available upon request by calling Computer Sciences Corporation at (800) 343 - 9000.

Updating Medicaid Provider File

Pursuant to Part 810 of OASAS regulations providers are required to obtain prior OASAS approval for certain changes in their operating status in order to maintain their operating certificates and Medicaid provider status in good-standing. Such changes, which must also be reported to DOH may include but are not limited to, changes in certified site locations, establishment of additional service locations and changes in ownership. Billing Medicaid for services provided at sites not currently certified by OASAS can result in Medicaid audit disallowances.

If a provider has given OASAS prior notification and received approval for changes to their operating certificate, as required by OASAS regulations, OASAS will provide DOH and the provider with the necessary written correspondence to update the Medicaid file. The DOH will send the provider confirmation of changes made to the Medicaid provider file.

Consolidated Fiscal Reporting

New providers will also be required to complete and submit the Consolidated Fiscal Report (CFR) to OASAS. Generally, New York City-based providers complete a CFR for the July to June reporting period and non-New York City-based providers complete a CFR for the calendar year reporting period. 

 

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Criminal Background Checks

All providers who contract with the Office of Alcoholism and Substance Abuse Services (OASAS) and/or are certified or otherwise authorized to provide services by OASAS are required to comply with this criminal background check process. 

Prospective employees, contractors and volunteers (applicants) who have been offered a position with your organization must undergo criminal background checks if they have the potential to or may be permitted to have regular and substantial unsupervised or unrestricted physical contact with service recipients. The provider is responsible for determining whether an applicant will have the potential to or may be permitted to have regular and substantial unsupervised or unrestricted physical contact with clients. 

 

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