NYS Medicaid- FFS billing provider or OPRA provider

[klapetri@ilovemygyn.com]

OB-GYN- New York (Long Island/Queens)

I received notification effective 9/1/2022 physician assistant and nurse practitioners must be enrolled or pending enrollment with NYS Medicaid as FFS provider or OPRA provider. When I contact NYS Medicaid they provide very little information and advise to go to their website.
Does anyone have additional information regarding this?
I appreciate your feedback!

 

[TThivierge]

Hi Klapetri
This means each of your PA and NP providers must be credentialed with the state Medicaid of NY. They will get assigned a special provider ID# to use on the claims for NY Medicaid once credentialing done and they signed the contract. You will probably need each license number, where/college got medical training, copy of malpractice insurance listed with office where work, each curriculum vitae, Etc. Any payer your office uses need to add these NP and PA providers by doing credentialing. Also you can use the CAQH info usually list online for each provider

I hope this data helps you
Lady T

 

[csperoni]

If for some reason, your NPPs have not already been enrolled in insurances, you should do so ASAP.
Not all carriers follow incident-to. Even for carriers that do follow Medicare's incident-to guidelines, it is almost impossible for your NPPs to provide only incident-to services and be fully productive.
Here's the NYS Medicaid site for provider enrollment. https://www.emedny.org/info/providerenrollment/

 

[klapetri@ilovemygyn.com]

I appreciate your feedback.
I'm enrolling NP/PA in Medicaid OPRA which means to only order/prescribe-
If not all insurance carriers follow incident to billing, then how do you bill?

 

[sls314]

I appreciate your feedback.
I'm enrolling NP/PA in Medicaid OPRA which means to only order/prescribe-
If not all insurance carriers follow incident to billing, then how do you bill?

The NP/PA would bill as the rendering provider under their own NPI.