Frequently Asked Questions

NYS Policy Top Question
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Historically, staff of OMH-licensed programs do not have to register individually to bill within a program. Has the requirement changed due to the 21st Century Cures Act?

Yes. Certain individual practitioners will now need to enroll as fee-for-service Medicaid providers to remain in Medicaid Managed Care Networks. If the agency is an enrollable type, it must enroll. As indicated on eMedNY Provider Index, OMH provider types that need to enroll include but are not limited to:

OMH Community Residence OMH Licensed ACT Provider

OMH Licensed Outpatient Provider OMH Licensed PROS Provider

OMH Licensed Residential Treatment Facility.

Enrolling and Billing are separate activities and processes. Not everyone who enrolls bills for services. Reiterating, if you are an enrollable type, you must enroll in Medicaid fee for service.

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

What type of licensed organizations/programs are required to enroll as Medicaid providers?

Enrollable types include (partial list):

  • OMH Community Residence 
  • OMH Licensed ACT Provider
  • OMH Licensed Outpatient Provider 
  • OMH Licensed PROS Provider
  • OMH Licensed Residential Treatment Facility 
  • Chemical Dependency Program (CDP)
  • OASAS Part 820 Residential Treatment Program
  • Bridges to Health Waiver Providers
  • Children's System Transformation Providers:
    • Children and Family Treatment and Support Servicces
    • Children's Home and Community Based Services

 

If the agency is an enrollable type, it must enroll. See eMedNY Provider Index for more information.

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

What licensed professionals providing care at enrolled organizations are required to enroll as Medicaid providers?

Licensed professionals that are enrollable types are required to enroll. This may include but is not limited to

  • LPNs and RNs
    • They can enroll as OPRA non-billing if in a facility. They will be listed as an Attending provider on the claim. 
    • If the nurse is a billing provider on a private duty nursing case, the nurse must enroll as a fee-for-service billable provider.
  • Physicians 
  • Nurse Practitioners 
  • Physician Assistants
  • Clinical psychologists
  • Licensed Clinical Social Workers

Licensed Master Social Workers and Licensed Mental Health Counselors are not enrollable provider types. 

See eMedNY Provider Index

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

Do we need to receive designation to provide Children's CFTSS/HCBS before we enroll for a provider number such as the Medicaid Management Information System (MMIS)?

Yes, you need to receive designation to provide Children and Family Treatment and Support Services (formerly SPA) and/or Children's HCBS before you enroll for a provider number such as the Medicaid Management Information System (MMIS).

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

If an agency offers Adult Behavioral Health Home and Community Based Services (BH HCBS), are they eligible to enroll as a Medicaid provider?

Adult BH HCBS is not an enrollable practitioner or agency type.

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

Where are the forms for Medicaid Provider Enrollment?

You can find the forms on the website. Provider Maintenance Forms can be found in the Provider maintenance form section. See the eMedNY Provider Index.

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

How will Managed Care Organizations (MCOs) address rostered providers at facilities that need to enroll but have not?

MCOs will receive updated monthly lists from the DOH Office of Health Insurance Programs for providers that need to enroll. It is up to the Managed Care Organization (MCO) to contact these providers to enroll. The public can access this list on Health Data website.

Source: OMH Medicaid Provider Enrollment Webinar 11.8.17

How do you become a Medicaid provider as part of an agency?

Both the organization where care is being provided and identified licensed practitioners individually need to be enrolled as Medicaid providers in order to bill Medicaid if the individual is an enrollable provider type. 

For more information, we recommend you listen to and review the following webinar, Medicaid Provider Enrollment for CFTSS and Children’s HCBS webinar.

Any individual practitioner can obtain an NPI number, but only certain practitioner types may enroll in Medicaid to obtain an MMIS number. 

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Source: July 2018 CFTSS Billing In-Person Training

Can non-licensed providers for CFTSS and children's HCBS, that do not have a NPI, use the unlicensed provider number?

Yes. Non-licensed providers for CFTSS and HCBS that do not have a NPI can use the OMH unlicensed provider number 02249154 or the OASAS unlicensed provider number 02249145

More information on filling out clean claims can be found on MCTAC Billing tool.

Source: CFTSS: OLP, PSR, CPST Billing and UM Office Hour 11.15.18

Can individuals providing CFTSS or children's Aligned HCBS who are not licensed practitioners get NPIs?

Non-licensed staff do not require an NPI. Practitioners who are able and required to enroll in Medicaid will need an NPI to enroll. 

Source: State January Roundtable 2019

Does a provider need a different Medicaid number as a Children and Family Treatment and Support Services provider if they are currently an enrolled provider for a program (i.e. PROS)?

Providers already enrolled in Medicaid do not need to re-enroll. The State will add the appropriate Category of Service code for the providers who have been designated for children’s services. 

The only time an agency would need to complete a Medicaid application is if the agency is  brand new and those providers should refer to the webinar at the following link for more information: Medicaid Provider Enrollment for CFTSS and Children’s HCBS webinar. 

  

Source: July 2018 CFTSS Billing In-Person Training

Do OPRA requirements apply to Article 29-I Facilities?

Yes. If the individual licensed practitioner is Medicaid enrollable, they must enroll and use their individual NPI number on claims.

If the individual practitioner is unlicensed or not a licensed enrollable Medicaid practitioner the OCFS (05448682) unlicensed practitioner ID may be used.

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Source: 2.10.21 Article 29-I Billing Office Hour