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  • Authorization To Release Protected Medicaid Member Information To A Third Party

Get Authorization To Release Protected Medicaid Member Information To A Third Party

NEW YORK STATE DEPARTMENT OF HEALTH OFFICE OF HEALTH INSURANCE PROGRAMS AUTHORIZATION TO RELEASE PROTECTED MEDICAID MEMBER INFORMATION TO A THIRD PARTY Medicaid Member Name (required): Date of Birth.

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Call Customer Service at 1-855-355-5777 and tell them you no longer want or need your appeal. You will receive confirmation of your request by mail.

Telephone: (855) 355-5777. Fax: (855) 900-5557. Online: .nystateofhealth.ny.gov. In Writing: New York State of Health. P.O. Box 11729. Albany, New York 12211.

Call the NY State of Health Customer Service Center at 1-855-355-5777 (TTY: 1-800-662-1220).

Call the HRA Medicaid Helpline at 888-692-6116 for more information.

Note: All planned, elective inpatient service requests require prior authorization.

Unfortunately, Medicaid has a requirement that it be repaid from any assets which remain at death. This is often referred to as “Medicaid Payback” or “Medicaid Estate Recovery”.

Enrollment Assistors offer free personalized help. To speak with the Marketplace Customer Service Center call (855) 355-5777 (TTY: 1-800-662-1220)

Prescribers obtain prior authorization for all these programs by calling the Medicaid Pharmacy Prior Authorization Clinical Call Center at 1-877-309-9493.

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© Copyright 1997-2025
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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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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:
1-877-389-0141
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