Medicaid Managed Care Network Providers & Medicaid Provider Enrollment. November 20, 2017
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1 Medicaid Managed Care Network Providers & Medicaid Provider Enrollment November 20, 2017
2 2 MCO outreach efforts Enrollments Medicare Enrollment Behavioral Health FAQs Contacts
3 3 Survey of MCO Outreach Efforts Mainstream Medicaid Managed Care Surveys were distributed to Managed Care PNDS contacts on October 25 th. MCOs were directed to cease all outreach efforts until survey is completed and DOH informs MCO it may resume provider enrollment outreach. Based on survey responses, 10 mainstream MCO s have been approved to resume with provider enrollment outreach. 3 mainstream MCO s are in the process of finalizing their outreach letters to providers that should not have been contacted. 4 mainstream MCO s have not responded to DOH s November 8 th communication that provided our survey review findings. DOH will continue to outreach with the 7 remaining mainstream plans. Beginning on 11/21, an updated active list of Medicaid FFS providers will be sent to those MCOs approved to continue outreach efforts (will include supervising pharmacists) Questions related to the survey from Mainstream Medicaid Managed Care Plans may be sent to bmcfhelp@health.ny.gov
4 4 Survey of MCO Outreach Efforts Medicaid Managed Long Term Care Surveys were distributed to Managed Care PNDS contacts on October 25 th. MCOs were directed to cease all outreach efforts until survey is completed and DOH informs MCO it may resume provider enrollment outreach. DOH review of survey responses still on-going. We anticipate survey finding communications to be distributed this week. Questions related to the survey from Medicaid Long Term Care Managed Care Plans may be sent to:
5 5 Enrollments Over the past month, the average number of new applications received weekly have increased by: 84% - Billing 458% - Non-billing (OPRA) Currently there are 13,000 enrollments/maintenance transactions pending DOH decision including those awaiting additional information from the provider On average, DOH processes 1,400 enrollments/maintenance transactions each week
6 6 Enrollments (cont d) New enrollments must be completed, with receipt of all necessary documentation, within 90 days otherwise the application is automatically withdrawn. Exception: If Medicare enrollment is needed, then additional 30 days is given DOH is working with CSRA to provide MCOs with a list of enrollments being tracked Enrollment tracking number (ETN) NPI number where available Provider name Status
7 7 Medicare Enrollment The following network provider types, who previously opted out of Medicare, must include the documentation they received from Medicare stating that they cannot apply for two years Clinical social worker Podiatrists Chiropractors Physical therapists
8 8 Behavioral Health DOH provided a presentation to Behavioral Health providers on 11/8/2017 Examples of Medicaid enrollment requirements for BH provider types: PROVIDER TYPE ENROLLMENT REQUIREMENT Licensed Mental Health Counselor Not required to enroll Licensed Marriage Family Therapist Not required to enroll CSW (Clinical Social Worker) Required to enroll (required to enroll in Medicare prior to Medicaid) Applied Behavioral Analyst Not required to enroll Adult Home And Community Based Services OMH Not required to enroll Children's Home and Community Based Services OMH Required to enroll LMSW (Licensed Master Social Worker) Not required to enroll A comprehensive list of provider types who can currently enroll in Medicaid (NYS Enrollable Providers) is located at:
9 9 Frequently Asked Questions FAQs are available, along with other resources, at: Check back frequently as FAQs will be updated as needed. In addition, a crosswalk of Medicaid FFS COS to PNDS specialty will be posted in the near future. Enforcement of Enrollment Requirement DOH is in the process of obtaining, from CMS, the enforcement date for the Medicaid enrollment requirement MCOs should not begin to terminate network providers until DOH provides guidance on the enforcement date
10 10 FAQs: Do they need to enroll? Provider Out of state, in-network providers Out of state, out-of-network providers In-network pharmacies, including out of state Out-of-network emergency providers Private Duty Nurses (LPN/RN) Non-Emergency Transportation Enrollment Requirement Required to enroll Guidance will be provided in the future Required to enroll Guidance will be provided in the future Required to enroll Required to enroll
11 11 FAQs: Licensed professions that can enroll as an Educator Licensed Profession Certified Asthma Educator (1) Certified Diabetes Educator (1) Pharmacists X X Registered Nurse RN X X Physician Assistant X X Nurse Practitioner X X Podiatrists X Respiratory Therapists Can only enroll as an Educator Dieticians/Nutritionist, Certified Can only enroll as an Educator (1) Educator must be salaried by a physician or clinic
12 12 FAQs: Providers where a NPI is not required for enrollment Original List COS Code Long Name NPI Required Bridges to Health (COS 0124) 124 BRIDGE TO HEALTH WAIVER N-NPI NO Managed Care (COS 0220) 220 PCPS: CAPITATION PROVIDER N-NPI NO Waiver Service (COS 0263) 263 WAIVER SERVICE N-NPI NO Vendor Personal Care Services (COS 0264) 264 HHAS: VENDOR PERSONAL CARE SERVICES N-NPI NO Personal Emergency Response Services (PERS) (COS 0266) 266 PCS: PERSONAL EMERGENCY RESPONSE SERVICES (PERS) N-NPI NO ALP (COS 0267) 267 ASSISTED LIVING PROGRAM (ALP) N-NPI NO OMR/DD Waiver Services (COS 0269) 269 HHAS: OMR/DD WAIVER SERVICES N-NPI NO Eyeglass Materials (Upstate) (COS 0408) 408 OS: EYEGLASS MATERIALS (UPSTATE) N-NPI NO Non-Emergency Transportation (COS 0602, , 0605, 0606, and 0609) 602 TRANS: INVALID COACH N-NPI NO Non-Emergency Transportation (COS 0602, , 0605, 0606, and 0609) 603 TRANS: TAXI N-NPI NO Non-Emergency Transportation (COS 0602, , 0605, 0606, and 0609) 604 TRANS: TRANS-MEDICAL/SURGICAL SUPPLIES N-NPI NO Non-Emergency Transportation (COS 0602, , 0605, 0606, and 0609) 605 TRANS: LIVERY SERVICES N-NPI NO Non-Emergency Transportation (COS 0602, , 0605, 0606, and 0609) 606 TRANS: DAY TREATMENT N-NPI NO Non-Emergency Transportation (COS 0602, , 0605, 0606, and 0609) 609 TRANS:TRANSPORTATION (OTHER) N-NPI NO Case Management Services (COS 0265) for rate codes 5210 through HHAS: CASE MANAGEMENT SERVICES N-NPI NO
13 Are there any questions? Mainstream, HARP and HIV-SNP: for general managed care questions, the MCO Outreach Survey, and the active list of Medicaid FFS providers, the Bureau of Managed Care Fiscal Oversight at Managed Long Term Care: for general managed care questions, For general provider enrollment questions, the Bureau of Provider Enrollment at emedny Call Center: (800)
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