NOTICE: Deadline Approaching for Managed Care Providers to Enroll with New York State Medicaid Program
7/28/2022
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Posted by Provider Relations
As stated in the April 2022 Medicaid Update article titled Medicaid Enrollment Requirements and Compliance Deadlines for Managed Care Providers, all Fidelis Care Medicaid Managed Care (MMC) network furnishing, ordering, prescribing, referring and attending (OPRA) providers must be enrolled with New York State (NYS) Medicaid program by August 31, 2022. Providers servicing MMC members should, without delay, begin the enrollment process and complete all required forms, including certifications.
Effective September 1, 2022, Fidelis Care will deny payment to unenrolled pharmacies, other unenrolled practitioners, and providers for services provided and/or prescribed.
Criteria for NYS Medicaid Enrollment
The enrollment requirement is applicable only to enrollable provider types including pharmacies and most licensed practitioners. Providers can refer to the NYS Enrollable Providers List, for further information.
Not all practitioner and pharmacy providers will meet criteria to qualify for enrollment. Providers can refer to the provider manuals available on the eMedNY "Provider Manuals" web page and on the eMedNY "Provider Enrollment and Maintenance" web page by selecting the appropriate provider type from the right-hand box titled "Provider List Filter".
Checking Enrollment Status
Providers can check their enrollment status by utilizing the tools available on the NYS DOH "Medicaid Enrolled Provider Lookup" web page. Providers can search by entering their NYS Medicaid Provider ID or their National Provider Identifier (NPI).
Providers who have submitted enrollment applications may check the status of their application in the Medicaid Pending Provider Listing file, which is updated weekly on the eMedNY "Medicaid Managed Care Network Provider Enrollment" web page.
If you have any questions, please contact your Fidelis Care Provider Relations Specialist, or connect with our Call Center at 1-888-FIDELIS (1-888-343-3547).