Starting Sept. 1, 2022, EmblemHealth will deny Medicaid, HARP, and Child Health Plus claims for providers (both in-network and out-of-network) who are not enrolled in the New York State Medicaid Fee-For-Service program (NYS Medicaid Program).
Section 5005(b)(2) of the 21st Century Cures Act requires all Medicaid Managed Care (MMC) networks’ furnishing, ordering, prescribing, and referring providers to be enrolled with State Medicaid programs as communicated in this January 2018 New York State (NYS) Medicaid Update Article. The NYS Medicaid Program adopted this enrollment requirement.
EmblemHealth will deny claims submitted by providers who are not enrolled or in a pending enrollment status with the NYS Medicaid Program as a billing provider or as an Order/Prescribe/Refer/Attend (OPRA) provider whether or not they are considered part of EmblemHealth’s network.