On April 20, 2020, the New York State Department of Health’s Bureau of Medicaid Provider Enrollment announced that expedited enrollment options – including online enrollment – are now available for temporarily enrolling providers who are responding to the coronavirus public health emergency. In addition to the expedited enrollment process, New York Medicaid is waiving application fees and the site visit and fingerprint-based criminal background check screening requirements for these applicants.
There are, however, limitations as to which providers may use the new expedited Provisional Temporary Provider Enrollment (PTPE) application process and the duration of such enrollment status.
Expedited enrollment is available only for nurses (LPNs and RNs), nurse practitioners, physicians and registered physician assistants who are not currently enrolled in New York Medicaid and who do not have a New York Medicaid enrollment application pending. Also, to be eligible, a provider must be enrolled in Medicare or another state’s Medicaid program or, alternatively, (i) must not be currently excluded from New York State Medicaid, (ii) cannot appear on the Office of Inspector General Exclusions Database, and (iii) must be licensed and legally authorized in at least one state or United States territory to practice or deliver the service for which they file professional services claims.
Most importantly, PTPE status, which can be retroactive to dates no earlier than March 1, 2020, will only remain in effect until the end of the public health emergency. Once that designation is lifted, PTPE will cease and providers who enrolled under this expedited process must complete the full New York Medicaid enrollment application. Otherwise, they will be terminated from the New York Medicaid program.
The PTPE application requires the following data elements:
- The provider’s or credentialer’s email address;
- The provider’s category of service (COS);
- The provider’s Social Security Number;
- The name of state where the provider is licensed for the COS on the PTPE application;
- The provider’s license number;
- The provider’s National Provider Identifier (NPI);
- The provider’s date of birth;
- The provider’s cell and work phone numbers;
- For physicians, nurse practitioners and registered physician assistants only, who are or will be affiliated with a group, the group name, group NPI, and whether the provider also has a private practice; and
- The provider’s home address (optional), correspondence address, pay-to address, taxpayer address, and name and address of service location.
Missing or unavailability of this information will result in a delay in the processing of the PTPE application.
In addition to providing the data elements listed above, providers must answer standard enrollment disclosure questions. Providers who answer any of the disclosure questions affirmatively, or who currently appear on the New York State excluded provider list and are seeking reinstatement, cannot enroll using the PTPE process, but rather are required to complete and submit both the full paper application and the Prior Conduct Questionnaire.
Expedited Submission of PTPE Applications
Multiple options, summarized below, are available for the submission of PTPE applications:
Option 1 – Online Form:
An online form for billing providers and for ordering, prescribing, referring, and/or attending (OPRA) providers can be accessed at: www.emedny.org/COVID19/. Instructions for completing and submitting the online form are found below the link to the form on the website. Please note that providers must click “Submit” on the online application form.
Option 2 – Email:
The Department of Health has created fillable PDFs of the billing provider and OPRA provider applications, both of which are also available at www.emedny.org/COVID19/, which requires only certain fields in these forms to be completed. Providers should refer to the instructions found directly below the PDF links. Completed forms should be saved, attached to an email, and forwarded for processing to emednycovid19PE@csra.com.
Option 3 – By Telephone (Individual Providers):
To complete an application by telephone, providers and/or credentialers should contact the eMedNY Call Center at (800) 343-9000; select menu option 2 and sub-option 4.
Option 4 – Enrolling Multiple Providers:
Credentialers who are enrolling multiple providers must contact the eMedNY Call Center at 800-343-9000 for assistance. eMedNY will provide a spreadsheet and the required fields must be completed for each provider who is applying for PTPE status.
Upon processing of the PTPE application, a written determination of approval or denial will be sent to the correspondence address.
Permanent Online Provider Portal is in Development
Prior to the current public health emergency, the Department of Health was in the process of developing an online provider portal to replace the existing paper-based enrollment process and thereby fully automating Medicaid enrollment for all providers; however, in response to the current public health emergency, the Department has refocused its efforts to implement the online process for PTPE applications. Therefore, the Online Provider Portal is not currently available for processing regular New York Medicaid enrollment applications.
The complete Medicaid Special Edition Update can be found at:
https://www.health.ny.gov/health_care/medicaid/program/update/2020/no08_2020-04-20_covid-19_provider_enrollment.htm
Please visit our Healthcare Law Practice Area to learn more about the legal services we can provide in this area. If you have any questions or would like more information on the issues discussed in this communication, please contact any of the Firm’s healthcare attorneys:
_________________
