New York Member Request For Specific Medicaid Protected Information is a process in which members of Medicaid in New York State can request for specific protected information about their Medicaid plan. This process allows members to access their medical records, pharmacy records, and other health related information that is protected by Medicaid regulations. The types of New York Member Request For Specific Medicaid Protected Information include: Medical Records, Pharmacy Records, Claims Information, Provider/Physician Information, and Eligibility Verification. Each type of request requires the member to provide proof of identity and authorization to access the requested information.
New York Member Request For Specific Medicaid Protected Information
State:
New York
Control #:
NY-DOH-5199
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PDF
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Member Request For Specific Medicaid Protected Information
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FAQ
Call the New York State Health Department's Growing Up Healthy Hotline at 1-800-522-5006, or contact your local county Department of Social Services. In New York City, call the Information Hotline at 311 or (718) 557-1399.
You may apply for Medicaid in the following ways: Through NY State of Health: The Official Health Plan Marketplace. Through a Managed Care Organization (MCO) Call the Medicaid Helpline (800) 541-2831. Through your Local Department of Social Services Office.
Prior authorization?sometimes called precertification or prior approval?is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
The member´s Medicaid MC Plan ID Card contains the Client Identification Number (CIN), which is unique to Medicaid members, and should be used to bill FFS. While in some cases the CIN may be embedded in the member's Medicaid MC Plan ID Number, it is always represented in this format: AA11111A.
The New York State Medicaid Pharmacy Program covers medically necessary FDA approved prescription drugs. Prescription drugs require a prescription order with appropriate required information. Certain drugs require the prescriber to obtain prior authorization before a prescription can be dispensed.
NYRx allows New York State to pay pharmacies directly for the drugs and supplies of Medicaid members. Prior to April 1, 2023, Mainstream Medicaid members accessed their pharmacy benefits through a health plan, rather than Medicaid Fee-For Service (NYRx).
+Requesting the Release of Information to a Medicaid Member Please call (518) 457-6323 if you have any questions.