The current telephonic IVR will still be available and can continue to be utilized for authorizations. The portal allows entry of information by practitioners and dispensing providers directly into a web portal rather than using a telephonic interactive voice response (IVR) system. The New York State Department of Health, Office of Health Insurance Programs, Bureau of Medical Review has launched a web portal for enteral formula authorizations. Pharmacies should review their inventory to ensure their supply will reflect this change.Īttention: Enteral Policy/Enteral Web Portal Training Webinar Effective May 8th, 2023, the Ventolin HFA BLTG criteria will be reinstated. The Department wanted to ensure member access to albuterol HFA products following the change in benefitįrom Medicaid Managed Care to NYRx, the Medicaid Pharmacy Program, on April 1st, 2023. On April 3rd, 2023, the brand-less-than-generic (BLTG) criteria was temporarily relaxed for Ventolin HFA, to allow pharmacists time to order the appropriate stock of that product for members. Click here to access the document.Īttention: *Program Update* - NYRx Providers Dispense Brand Name Drug when Less Expensive than Generic Program If a patient has a work-related injury, for which they have an open Workers Compensation case, Workers’ compensation coverage must be utilized prior to billing the NYRx Medicaid Pharmacy Program.Īttention: A DMEPOS Provider Communication is Now AvailableĪ Provider Communication, "Information for Physicians and other Practitioners who prescribe Enteral Products for Medicaid Members, including Members affected by the Managed Care NYRx/ Fee for Service Transition" has been posted. This includes Workers Compensation Coverage. Providers should always ask a Medicaid member if they have other third-party coverage to ensure the proper coordination of benefits. The article titled Reminder: Medicaid Requires Coordination of Benefits, published in the November 2021 issue of the Medicaid Update, directed providers to exhaust all existing benefits prior to billing the Medicaid program. Medicaid is always the payor of last resort and federal regulations require that all other available resources be used before Medicaid considers payment. New York State (NYS) Medicaid providers are required to bill applicable third parties that may be liable for a claim before billing NYS Medicaid. These should be submitted in NCPDP Processor Control NCPDP filed 104-A4.Īttention: Coordination of Benefits & Workers Compensation Coverage To submit ECCA transactions, a Personal Identification Number (PIN) is required.Īdditionally, the pharmacy must have an Electronic Transmitter Identification Number (ETIN) on file with eMedNY. We look forward to hearing from you!Īttention: Important Information Regarding Electronic Claims Capture and Adjudication (ECCA) for Pharmacy Providers The survey link will be active beginning on June 13th. Please help us make the most of this opportunity by encouraging participation that helps us improve the provider experience! Visit /Survey to participate. We would like your input on any of the methods you have used to contact HealthHelp. HealthHelp provides easy ways for you to obtain authorizations: fax, phone authorization through call center, and IVR automated touch phone system. Edit/Error Knowledge Base (EEKB) Search ToolĪttention: A DME Provider Communication is Now Available The document, "Enteral Product Classification List 2023" has been posted.Īttention: HealthHelp's Provider Satisfaction Survey is going out to providers and facilities beginning June 13, 2023Īs a user of Consult, specialty benefits management services administered by HealthHelp, your feedback is vital for improving our processes.National Diabetes Prevention Program (NDPP).Medicaid Managed Care Network Providers.Enrolled Practitioners SEARCH (including OPRA).
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