Medicaid Provider Enrollment NEW AND EXISTING PROVIDERS OF CHILDREN S SPA AND HCBS 9/28/2017
Rules To bill and be reimbursed by Medicaid for services provided: Provider Agencies need to be enrolled in Medicaid. Provider agencies and individual staff providing SPA and HCBS need to have an National Provider Identifier (NPI) number to ensure proper reimbursement. Provider Agencies enrolled as a Medicaid provider need to have their NPI associated with their Medicaid Provider number. 2
Provider Agencies need to have the correct Category of Service (COS 0268) on their Medicaid number. 1. Agencies already enrolled in Medicaid with an associated NPI, but not with the 0268 COS will have this COS added. 2. Agencies who do not have an NPI associated with their enrollment will need to contact OCFS or DOH Provider Enrollment directly. 3
Possible Scenarios Scenario # 1.Provider Agency not enrolled in NYS Medicaid. Scenario # 2. Provider Agency enrolled in NYS Medicaid with NPI but no COS 0268. Scenario # 3. Provider Agency enrolled in NYS Medicaid but no NPI or COS 0268. B2H Providers, please contact OCFS at 518-408-4064. Care at Home Providers, please call 518-474-5271. 4
Scenario # 1.Provider Agency not enrolled in NYS Medicaid. Apply for NPI Complete and submit the Children s SPA/HCBS Provider Designation application Upon receiving NYS designation approval, complete and submit the Medicaid Provider Enrollment Application with NYS approved designation letter 5
Scenario # 2. Provider Agency enrolled in NYS Medicaid with NPI but no COS 0268. A list of Medicaid Provider Numbers will be sent to DOH Provider Enrollment along with a copy of the designation letter and the effective date of designation. This Medicaid Number will be taken from your designation application. 6
Scenario # 3. Provider Agency enrolled in NYS Medicaid but no NPI or COS 0268. B2H Providers, please contact OCFS at 518-408-4064. Care at Home Providers, please call 518-474-5271. For questions about the Medicaid application, please contact CSRA at 800-343-9000 or the Provider Enrollment Mailbox: providerenrollment@health.ny.gov 7
Obtaining an NPI Choose the appropriate taxonomy code to be entered in the NPI application, articulated on slides 9-11. All Agency Provider and Individual Staff (licensed/non-licensed) must apply for a National Provider Identifier (NPI) from the National Plan and Provider Enumeration System (NPPES). An Agency Provider must select the Healthcare Provider Taxonomy Code which is a description the provider determines most closely describes the provider's type/classification/specialization. Individual Staff: Select the taxonomy code for a licensed individual if you are licensed or for a non-licensed individual if you are not. 8
Selecting an NPI Taxonomy Code (Organization) http://www.wpc-edi.com/reference/codelists/healthcare/health-careprovider-taxonomy-code-set/ (Sample from above link) Non-individual Agencies [definition] Community/Behavioral Health - 251S00000X [definition] A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. Foster Care Agency - 253J00000X [definition] A Foster Care Agency is an agency that provides foster care as defined in the Code of Federal Regulations (CFR) as "24-hour substitute care for children outside their own homes." Foster care settings include, but are not limited to, nonrelative foster family homes, relative foster homes (whether payments are being made or not), group homes, emergency shelters, residential facilities, and pre-adoptive homes. 9
Selecting an NPI Taxonomy Code (Licensed individuals within an agency) http://www.wpc-edi.com/reference/codelists/healthcare/health-care-provider-taxonomy-codeset/ (Sample from above link) Individual or Groups (of Individuals) Behavioral Health & Social Service Providers [definition] Social Worker - 104100000X [definition] A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public. Clinical - 1041C0700X [definition] School - 1041S0200X [definition] 10
Selecting an NPI Taxonomy Code (Unlicensed individuals within an agency) http://www.wpc-edi.com/reference/codelists/healthcare/health-care-provider-taxonomy-codeset/ (Sample from above link) Other Service Providers [definition] Peer Specialist - 175T00000X [definition] Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. 11
Applying for an NPI https://nppes.cms.hhs.gov/# (Create Login) Create Login 12
Click Accept 13
Enter Required Informationclick Submit
Create User ID, password and select 5 security questions/answers 16
Enter required information
Click here Once completed you will receive an email stating that, you have successfully registered as a user of the Identity and Access (I&A system) This email will contain your account information: 1. Name 2. User ID 3. Date of Registration 18
Click register for an NPI to go back to original NPI screen 19
20 Completing an NPI Application https://nppes.cms.hhs.gov/#/ Enter User ID/passwor d hit sign in
Applying as a Medicaid Provider After NPI application is complete for provider agency, proceed to Medicaid Provider Enrollment Application. Application is on the Department of Health website: https://www.emedny.org/info/providerenrollment/index.aspx Once enrolled, the correct rate codes and rates will be assigned to the Agency Medicaid Provider Number. 21
Children s Health & Behavioral Transformation 22
Additional information required for new Medicaid Providers. Medicaid Enrollment Application Instructions Medicaid Enrollment Application 23
All required documents must be submitted with the enrollment application. Incomplete forms will result in delaying the application. 24
A copy of the designation letter must be submitted with this form along with the other required documents listed. Additional requirements for Medicaid Provider Enrollment Application
Already a Medicaid Provider Medicaid Provider Numbers will be taken from the designation application and sent to DOH Provider Enrollment along with a copy of your designation letter to have the COS 0268 added if needed. Once the COS 0268 is added to your Agency Medicaid Provider Number, the correct rate codes and rates will be assigned. 26
NYS Agency Contacts Office of Children & Family Services-518-408-4064 Department of Health Care at Home-518-474-5271 Contact CSRA at 800-343-9000 or Department of Health Provider Enrollment- providerenrollment@health.ny.gov 27