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M & Fax to the Rate Based Provider Bureau Please Photocopy & Complete a separate form for each NPI you wish to enroll PROVIDER NAME & FEIN NUMBER REQUEST TO ENROLL UNREPORTED OR NEW NPI Name: FEIN No.: PHYSICAL ADDRESS OF FACILITY NPI: Street Address Primary Taxonomy Code: Secondary Taxonomy Code: City, State, Zip Code: ADDRESS TO SEND FORM(S) / CONTACT INFO / AUTHORIZATION Name: Medicaid Services to be billed using this NPI: Street Address: City, State,.

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In 2023, New York's Medicaid limit increased to 138% FPL. The QMB limit increased from 100% FPL to 138% FPL. SLMB was eliminated. QI increased from 135% FPL to 186% FPL.

Effective September 22, 2022, the New York State (NYS) Medicaid fee-for-service (FFS) professional dispensing fee will change from $10.08 to $10.18 for covered outpatient drugs, when applicable.

For more information, call the Medicaid Helpline at 1-888-692-6116 or visit the NYS website.

Note: Customer Service: (800) 343-9000.

Contact the eMedNY Call Center at 1-800-343-9000 to begin the enrollment process.

Claims Submission Professional service providers may submit their claims to NYS Medicaid using electronic or paper formats. Providers are required to submit an Electronic/Paper Transmitter Identification Number (ETIN) Application and a Certification Statement before submitting claims to NYS Medicaid.

Local Department of Social Services. Your Local Department of Social Services (LDSS) may be able to assist you in obtaining your health insurance coverage and/or provide you with information about other programs and benefits you may qualify.

Each month in which you need Medicaid services, bring in, send or fax (if available in your county) your paid or unpaid medical bills to your local department of social services. Only send these bills when they are equal to or more than the amount of your excess income.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232