Medicaid Pharmacy Carve-Out Special Edition – Part Two
March 2021Volume 37 Number 4Medicaid Pharmacy Carve-OutSpecial Edition – Part TwoEffective May 1, 2021, Medicaid members enrolled in mainstream Medicaid Managed Care (MC) Plans,Health and Recovery Plans (HARPs), and HIV-Special Needs Plans (SNPs) will receive their pharmacybenefits through the Medicaid Fee-For-Service (FFS) Pharmacy Program instead of through their MedicaidMC Plan. This guidance provides information in addition to what was provided in the Medicaid Update 020,locatedat:https://www.health.ny.gov/health care/medicaid/program/update/2020/docs/mu no17 dec20 speced pr.pdf.Information for PharmaciesDetermining a Member’s Identification (ID) Number and Checking EligibilityEffective May 1, 2021, each Medicaid MC Plan will implement point-of-service claim denial messaging thatdirects pharmacies to bill the FFS program where applicable. The members Medicaid MC Plan ID cardcontains the Client Identification Number (CIN), which is unique to Medicaid members, and should be usedto 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 CIN can be found on both the members Plan ID Cardand FFS Client Benefit Identification Card (CBIC).Continued on Page *************
Andrew M. CuomoGovernorState of New YorkHoward A. Zucker, M.D., J.D.CommissionerNew York StateDepartment of HealthDonna FrescatoreMedicaid DirectorOffice of Health Insurance ProgramsThe Medicaid Update is a monthly publication of the New York State Department of Health.In This Issue Medicaid Pharmacy Carve-Out .CoverInformation for Pharmacies.1Information for All Providers (Including Pharmacies).6Provider Enrollment.7Appendix A: PA Guidance for DMEPOS .9Appendix B: Resources .10Appendix C: Member Fact Sheet.13Provider Directory .14Special Edition: Pharmacy Carve-Out New York State Medicaid Updatepg. 2
The chart shown below illustrates where the CIN can be found on each plan ID card, located on the teat:https://mmcdruginformation.nysdoh.suny.edu/. In a future update, NYS DOH will provide the claim denialmessaging that will be used by Medicaid MC Plans, starting May 1, 2021.Medicaid MC Plan ID Card:Plan NameMember’s Plan ID#:Member Plan ID# is CIN, Embedded in Plan ID# orCIN Shown Separately on Plan CardAffinityCIN Shown Separately in Plan CardAmidaCareMember Plan ID# is CINCDPHPEmbedded in Member’s Plan ID#EmblemHealthEmbedded in Member’s Plan ID#FidelisCIN Shown Separately on Plan CardExcellusCIN Shown Separately on Plan CardHealthfirstMember Plan ID# is CINHealthNowMember Plan ID# is CINHealthPlusMember Plan ID# is CINIndependent HealthEmbedded in Member’s Plan ID#Metro PlusMember Plan ID# is CINMolinaMember Plan ID# is CINMVPCIN Shown Separately on Plan CardUnited HealthcareCIN Shown Separately on Plan CardVNSNY ChoiceMember Plan ID# is CINPharmacists may also conduct an eligibility check and/or obtain the member’s CIN, by using one of themethods in the chart below. When submitting FFS claims to Medicaid via the NCPDP D.0 format, the BankIdentification Number (BIN) and Processor Control Number (PCN) are required. Specific details can be foundthe Medicaid Update Special Edition – Part One, issued Friday, December 18, 2020, found at:https://www.health.ny.gov/health care/medicaid/program/update/2020/docs/mu no17 dec20 speced pr.pdf. Medicaid member’s may also contact the Medicaid Consumer Helpline by calling (800) 541-2831 to obtaintheir CIN.Special Edition: Pharmacy Carve-Out New York State Medicaid Updatepg. 3
Methods to Check Eligibility or Obtain the CIN:MethodSummaryE1Eligibility VerificationTransactio Instructions to complete this transactionnbegin on page 10 of the resourcedocument mProviders must have an ePACESaccount and the following information to:Obtain CINx First and Last Namex DOBx SSNx GenderEligibility Verificationx First and Last Namex DOBx SSN or CINx GenderEligibility VerificationProviders must have the followinginformation:x CINx Provider’s National ProviderIdentifier (NPI) OR MMIS Numberx Ordering Provider NPI (ifapplicable)ResourcesNYS DOH Electronic Pharmacy Claim Format(NCPDP) D.0 Standard Companion GuideTransaction Information tions/NCPDP D.0 Companion Guide.pdfePACES Login webpage:https://www.emedny.org/epaces/ePACES MEVS Eligibility Request /QuickRefDocs/ePACES-Eligibility Request.pdfNYS Program’s MEVS Instructions forCompleting a Telephone Transaction 10/MEVS%20Quick%20Reference%20Guides/5010 MEVS Telephone Quick Reference Guide.pdfIdentifying Transition FillsAs previously noted in the December 2020 Special Edition issue of the Medicaid Update(https://www.health.ny.gov/health care/medicaid/program/update/2020/docs/mu no17 dec20 speced pr.pdf), a one-time “transition fill” will be allowed for non-preferred drugs and diabetic supplies. These transitionfills can be identified as indicated below. Pharmacists may work with the patient and physician on future priorauthorization (PA) requests or, where appropriate, medication changes to preferred options.x The eMedNY claims processing system will be populating NCPDP field 548-6F, Approved MessageCode, with code “005” — Claim paid under the plan's transition benefit period, otherwise claim wouldhave rejected as PA is required.Billing for undat:https://health.ny.gov/health care/medicaid/redesign/mrt2/pharmacy carve out/docs/rx carve out scope.pdf, vaccines that are administered by pharmacists are subject to the carve-out and should be billed to FFS.Policy and billing instructions for the administration for COVID-19 vaccines can be found within the NYSMedicaid Coverage Policy and Billing Guidance for the Administration of COVID-19 Vaccines Authorized alth care/medicaid/covid19/guidance/docs/billing guidance.pdf. Policy and billingguidance for other vaccines can be found within the NYS Medicaid FFS Program Pharmacists as y.gov/health care/medicaid/program/docs/phar immun fact.pdf.Special Edition: Pharmacy Carve-Out New York State Medicaid Updatepg. 4
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) — Coverage and BillingGuidanceScopeofBenefitsdocument,foundat:x Thehttps://health.ny.gov/health care/medicaid/redesign/mrt2/pharmacy carve out/docs/rx carve out scope.pdf, provides a summary of DMEPOS items that are subject to the carve-out. Items that are notsubject to the carve-out will remain the responsibility of the MC Plans and are listed in Appendix A ofthis document.x The items subject to the carve-out are listed in sections 4.1, 4.2, and 4.3 of the DMEPOS – DME Procedure Codes.pdf, should be billedto FFS. Most items do not require additional authorization prior to dispensing and billing. These itemsmay be dispensed and billed directly to Medicaid.x The items in sections 4.4, 4.5, 4.6, and 4.7 of the Durable Medical Equipment, Prosthetics, Orthotics,Supplies – Procedure Codes and Coverage Guidelines document, found /DME Procedure Codes.pdf, are not subjectto the carve-out and should continue to be billed to the member’s MC plan.x There are some DMEPOS items subject to the carve-out, that require pre-approval. To ensure asmooth transition for Medicaid MC member’s, PA requirements will be temporarily relaxed (e.g.claims will not deny). NYS DOH staff will monitor these claims and outreach to providers to assistthem in obtaining the appropriate authorizations for future claims. At a future date, providers will begiven notice regarding when PA requirements will commence. For reference, PA instructions may befound within the Appendix A: PA Guidance for DMEPOS section of this issue’s Medicaid Update.Billing Instructions for DMEPOSThe table below provides billing instructions for DMEPOS items subject to the carve-out.Claim FormatInstructionsNCPDP andWhen billing electronically for medical supplies:000301 paperx Place procedure code in the National Drug Code (NDC) field with leading zeros.claim formEnter the five-character code from the NYS Medicaid Program PharmacyProcedure Codes document in the last five spaces of the NDC field, found /PDFS/Pharmacy Procedure Codes.pdf.x NCPDP Field Names: Product/Service ID- 407-D7 and Product/Service IDQualifier- 436-E1 (valid values 01 NDC,09 Healthcare Common ProcedureCoding System (HCPCS).x Items must be billed to Medicaid FFS using the HCPCS code in the DMEPOSProcedure Codes and Coverage Guidelines - (alphanumeric form, example“A4259”) should be submitted in the 11-digit NDC field with leading zeros. Ifproviders submit claim using an NDC number, the claim will deny with rejectmessages indicated below:NCPDP ResponseCode/MessageNCPDP Reject CodeProfessional/Medical ClaimFormat 837Professional837-P) orCode“705”“77”MessageNDC/Antibody Drug Conjugate (ADC) NotCoveredDiscontinued NDC NumberWhen billing by paper, refer to the NYS eMedNY Billing Guidelines document, found /PDFS/Pharmacy Billing Guidelines.pdf.When billing by electronic or paper, refer to the NYS 150003 Billing Guidelines –DMEPOS, Orthopedic Footwear, Orthotic and Prosthetic Appliance document, found /DME Billing Guidelines.pdf.Special Edition: Pharmacy Carve-Out New York State Medicaid Updatepg. 5
paper 150003form*Point ofServiceClaims(ePACES) Real-timeDMEPOSclaimssubmissionsWhen submitting claims, refer to the ePACES Professional Real Time Claim ReferenceGuide, found 0 ePACES Professional Real Time Claim Reference Guide.pdf.*Pharmacies that choose to bill via the professional or medical claim format need to have a Medicaid Category of Service (COS) of“0442”, assigned to them through the enrollment process.Brand Less than Generic (BLTG) ProgramThe BLTG program is an initiative that promotes the use of certain multi-source brand name drugs when thecost of the brand name drug is less expensive than the generic equivalent. For a current listing of brand namedrugs included in the BLTG program, refer to the most recent program update on the BLTG Program webpage at: https://newyork.fhsc.com/providers/bltgp about.asp.Pharmacies will receive the following denial message when submitting claims for generic drugs in the BLTGprogram. Denials for generics can be avoided by dispensing the brand name products. A new prescription isnot required.Pharmacy Claim Denial Message:CodeNCPDP Response“421”Code/MessageNCPDP RejectCode/Message“78”MessageDispense Brand DrugInstead of GenericEquivalentCost Exceeds MaximumInformation for All Providers (Including Pharmacies)Member Fact SheetPlease use the Member Fact Sheet, found within the Appendix C: Member Fact Sheet section of this issue’sMedicaid Update, to provide members with the resources and information they need regarding the carve-out.A print-friendly version of the Member Fact Sheet is available in multiple languages on the eMedNY MemberMedicaid Pharmacy Benefit web page at: https://member.emedny.org/.Prescription Limits Change — Duration and RefillsEffective May 1, 2021, prescriptions will be valid and may be filled for up to one year from the date issued.After the prescription expires, a new prescription will be required from the prescriber, even if refills remain onthe original prescription. This is a change from the current FFS practice, where prescriptions are valid for onlysix months and must be filled within 60 days of the date issued.Updates to the Medicaid FFS Formulary (List of Reimbursable Drugs)NYS DOH recognizes the need for certain drugs requiring administration by a practitioner to be availablethrough the Medical and Pharmacy Benefit. Such practitioner administered drugs are listed on e.aspx, and may be billed directly to the FFS program by a pharmacy.Practitioner administered drugs billed as a Medical claim should be billed to the member’s Medicaid MC Plan.Special Edition: Pharmacy Carve-Out New York State Medicaid Updatepg. 6
NYS DOH analyzed practitioner administered drugs that are provided as a pharmacy benefit through theMedicaid MC Plans. As a result of this analysis, NYS DOH will add certain practitioner administered drugs tothe FFS formulary. These drugs can be found on the NYS DOH List of Physician Administered Drugs t:https://www.health.ny.gov/health care/medicaid/redesign/mrt2/pharmacy carve out/docs/drugs added reimbusable.pdf. Practitioner administered drugs dispensed as a Pharmacy Benefit must be delivered by thepharmacy directly to the site of administration. Requirements for delivery can be found on page 7 of theAugust 2019 issue (https://www.health.ny.gov/health care/medicaid/program/update/2019/aug19 mu.pdf) ofthe Medicaid Update. These requirements ensure proper storage and handling.Diabetic /health.ny.gov/health care/medicaid/redesign/mrt2/pharmacy carve out/docs/rx carve out scope.pdf, provides a summary of diabetic supply items that are subject to the carve-out. Diabetic Diagnostics andDaily Care- Glucose Testing Supplies, Disposable Insulin Pumps (Omnipod); Continuous Glucose Monitor(CGM); and Insulin Syringes, Needles, Pens, Infusion Supplies, will be transitioned to the FFS program. TheFFS program covers all of these items, some of which are part of the Preferred Diabetic Supply Program(PDSP), found at: s.asp. Items that are not listed on thepreferred diabetic supply list are subject to PA.NYS DOH will allow a one-time transition fill from May 1, 2021, through July 30,2021, for non-preferreddiabetic supplies that are part of the PDSP and will honor PAs already provided by the Medicaid MC Plans.Over the Counter (OTC) DrugsThere are some NDCs that may have been covered by the Medicaid MC Plans, that are not covered by FFS.However, there are equivalent/comparable NDCs available through FFS. OTC drugs covered by MedicaidFFS can be found on eMedNY’s Medicaid Pharmacy List of Reimbursable Drugs web page der EnrollmentPrescribersAfter May 1, 2021, Medicaid FFS will continue to pay for covered products for Medicaid MC member’s, evenfor prescribers that have not yet enrolled in the FFS program. However, prescribers should enroll by July30, 2021, to ensure that they can continue to prescribe for Medicaid member’s in the future.Physicians, Nurse Practitioners or Physician Assistants may use the options below for enrolling as anOrdering Prescribing Referring Attending (OPRA) provider.xxEnroll quickly online throughout the COVID-19 public health emergency (PHE) through the lment/COVID19/. Prescribers that choose this option willneed to fully enroll as an OPRA provider, within 60 days after the end of the PHE: or,Fully enroll as an OPRA provider using the process described below. While this process takes longerthan the PTPE process, no additional enrollment action will be required when the PHE ends.o VisiteMedNY’s .o Select “Practitioner” from the Provider List Filter on the right-hand side of the page.o Select provider licensed profession (provider type).Special Edition: Pharmacy Carve-Out New York State Medicaid Updatepg. 7
Podiatrists, Dentists, Optometrists, Audiologists, Certified Nurse MidwivesPodiatrists, Dentists, Optometrists, Audiologists, Certified Nurse Midwives may enroll using the processdescribed below. When using this process, no additional enrollment action will be required when the PHEends.x ment/index.aspx.x Select “Practitioner” from the Provider List Filter on the right-hand side of the page.x Select provider licensed profession (provider type).Full enrollment as a Medicaid FFS billing provider is also an option, for those providers that wish to bill theFFS program for all covered services, in addition to prescribing. Information regarding how to enroll as aMedicaid FFS billing provider can be found on the eMedNY Provider and Maintenance Billing Medicaid webpage at: sician/Option1.aspx. When using this process,no additional enrollment action will be required when the PHE ends.PharmaciesPharmacies not currently enrolled in the FFS program, that wish to continue to service NYS Medicaid MCmember’s, will need to enroll. NYS DOH has updated the Pharmacy Enrollment Policy, found within cy/PDFS/Pharmacy Policy Guidelines.pdf, which allowsenrollment of community-based pharmacies located in New York or in the bordering states (Connecticut,Massachusetts, New Jersey, Pennsylvania and Vermont). The policy also provides a pathway for enrollmentfor pharmacies servicing NYS Medicaid MC member’s that are located outside of New York and outside ofthe bordering states.During the PHE, pharmacies have the ability to enroll provisionally, where certain enrollment requirementswill be waived. Pharmacies that enroll provisionally, will be required to fully enroll 60 days after the end of thePHE.The following guidance is applicable for pharmacies who choose to submit enrollment applications via theCOVID-19 PTPE portal:x Pharmacies with the Category of Service (COS) “0441” (Freestanding Pharmacy) or “0442”(Freestanding Pharmacy-Based DME) may now submit enrollment applications through the COVID19 PTPE portal, located at: https://pe.emedny.org/. Enrolling through this portal allows for a quickerturnaround time.x Pharmacies must first create a provider portal account. For instructions on how to create a providerportal account, visit eMedNY’s How to Create Your New eMedNY ID and Log into the COVID-19 PTPEweb page, found at: https://www.emedny.org/COVID19/emednyID.aspx. Please note, providers willbe required to validate their account with a Verification Code sent to the email used to sign up.For questions regarding enrolling in the COVID-19 PTPE portal, please contact the eMedNY Call Center at(800) 343-9000 or visit eMedNY’s Pharmacy Carve-Out web page at: https://www.emedny.org/carve-out/.DMEPOS ProvidersThe updated DMEPOS Provider Enrollment Policy can be found within the NYS Medicaid Program nuals/DME/PDFS/DME Policy Section.pdf. DMEPOS providers thatare located outside NYS may apply for enrollment if they meet the newly established guidelines. DMEPOSproviders located in states bordering New York may enroll if they support NYS Medicaid member’s in thecommon medical marketing area. Out-of-state DMEPOS manufacturers and mail order suppliers may also beconsidered on a case-by-case basis, as outlined in the NYS Medicaid ProgramDME Manual Policy Guidelinesdocument.Special Edition: Pharmacy Carve-Out New York State Medicaid Updatepg. 8
Information about the DME Supplier application process can be found on the eMedNY Provider Enrollmentand Maintenance DME web page at: /index.aspx.Physician DispensersFor the current FFS policy regarding physician dispensers, refer to the Practitioner Dispensing article locatedat:https://www.health.ny.gov/health care/medicaid/program/update/2021/no01 2021-01.htm. Physicians whoare already enrolled in Medicaid FFS as a Physician - Individual Billing Medicaid (Category of Service 0460)or Practitioner Group (Category of Service 0046 or 0090), may apply as a Physician Dispenser, by completingthe Request for Dispensing Physicians to Bill Pharmacy Claims form, found ProviderMaintForms/408602 Request for Dispensing Physicians to Bill Pharmacy Claims.pdf.Appendix A: PA Guidance for DMEPOSDMEPOS billing identifier found in the NYS Medicaid Program DMEPOS Procedure Codes and CoverageGuidelines document /DME Procedure Codes.pdf.DMEPOS BillingResourcesHCPCS code isx Used to obtain automated authorizations for equipment and supplies.preceded by a poundx For general ePACES information visit the eMedNY Submit Electronicsign (#).Transactions to New York Medicaid (Free of Charge) via ePACES webpage at:Prior S/ePACES GeneralInfo.aspx.x For ePACES DVS reference guidance, refer to the Step-by-StepSubmitted through theInstructions for ePACES PA/DVS - DME DV document, found at:Dispensing s/ePACES DME DVS RSystem (DVS) throughequest Response Cheat Sheet.pdf.ePACES.HCPCS Code isx NYS DOH staff review to determine medically necessity or quantity orunderlined.frequency limits overrides.x For DME PA guidelines, refer to the NYS Medicaid Program DME PAPrior AuthorizationGuidelines document, found /DME PA GuideSubmitted on paper, bylines.pdf.a Health Insurancex For ePACES PA guidelines, refer to the Step-by-Step Instructions forPortability andePACES PA/DVS - DME DV document, found at:Accountability S DME DVS R(HIPAA) 278 transactionequest Response Cheat Sheet.pdf.or electronically usingx For ePACES PA/DVS guidance, refer to the ePACES PA/DVS RequestePACES.document, found SDVS Request.pdf.x Paper PA forms (EMEDNY-361502 for paper submission) are availableby contacting eMedNY at (800) 343-9000 or at the following address:eMedNYPO Box 4600, Rensselaer, NY 12144-4600HCPCS Code ispreceded by an asterisk(*)xxFor instructions on completing paper PA forms, refer to the NYSMedicaid Program DME PA Guidelines document, found /DME PA Guidelines.pdf.Enteral Formula onlyContact: (866) 211-1736Special Edition: Pharmacy Carve-Out New York State Medicaid Updatepg. 9
DiRAD Interactive VoiceResponse System (IVR)xxxxPrescriber calls and enters medical information and gets anauthorization number and records that on the fiscal order.Dispensing provider (DME or Pharmacy) calls and completes theauthorization process.The NYS Medicaid Program’s Enteral Formula PA rManuals/communications/PrescriberWorksheet Instructions.pdf) and Enteral Formula PA Manuals/communications/Dispenser%20Worksheet.pdf) are available to assist in the authorization process.PA required for all requests that cannot be completed through the IVR.Appendix B: ResourcesTopicClaimsProcessing forOutpatientPharmacyBenefitsPriorAuthorizationfor DrugsDurableMedicalEquipment,Prosthetics,Orthotics ingbilling andpharmacyclaimsprocessing,lost or stolenmedicationsandremittances.Questionsregarding PAor Inquiriesaboutquantity/age/day’s supplyand other editsor medicationquestions.ResourcesContactWebsite LinksInformationClaimseMedNYGeneral Information found on the eMedNY homeSupport:page:(800) 343https://www.emedny.org/9000, OptioneMedNY Pharmacy Manual web acy/index.aspxMagellanClinical CallCenter:(877) 3099493NYS DOH NCPDP D.0 Standard Companion GuideTransaction Information tions/NCPDP D.0 Companion Guide.pdfMagellan Health, Inc.’s NYS Medicaid PharmacyProgram web page: https://newyork.fhsc.com/Magellan Health, Inc.’s NYS Medicaid PharmacyProgram PDL Listserv email notification sign-up webpage: https://newyork.fhsc.com/providers/notify.aspPA RequestForm s/providers/NYRx PDP PA FaxStandardized.pdfQuestionseMedNY DME Manual web page:(800) 342regarding DME 3005https://www.emedny.org/ProviderManuals/DME/PA; pendedclaims; andohipmedpa@hearing aidshealth.ny.govSpecial Edition: Pharmacy Carve-Out New York State Medicaid Updatepg. 10
Procedures ns(FAQs)FAQsEligibilityVerification andePACESQuestionsrelated toePACES or forassistance withbilling RecipientProgramProviders maydirectmember’srequesting achange ofpharmacy orprovider forrestrictions tothe OMIG forassistance.FFS PreferredDrug List (PDL)The FFS PDLcontains a fulllisting ofdrugs/classessubject to theNYS MedicaidFFS PharmacyPrograms.Providers mayreview theMedicaidPharmacy ListofReimbursableDrugs forproductscovered.For questionsrelated to thePharmacyProgram, 340BBilling, DrugMedicaid List ram, Policyand CoverageN/ACarve-OutTransition (Carve-Out) of the Pharmacy Benefit fromMC to FFS –FAQs document:https://health.ny.gov/health care/medicaid/redesign/mrt2/pharmacy carve out/docs/pharm carve out faq.pdfEligibilityeMedNYePACES Help/Log-in web page:Support:https://www.emedny.org/epaces(800) 3439000, Option NYS Programs MEVS Instructions for Completing aTelephone Transaction 010/MEVS%20Quick%20Reference%20Guides/5010 MEVSTouchtoneTelephone Quick Reference Guide.pdfTelephoneVerificationSystem:(800) 9971111Office of theN/AMedicaidInspectorGeneral(OMIG):(518) 4746866Policy and Program InformationMagellanMagellan Health, Inc.’s NYS Medicaid PharmacyClinical CallProgram web page: https://newyork.fhsc.com/Center:(877) 3099493Questionsmay bedirected toPPNO@health.ny.gov.eMedNY’s Medicaid Pharmacy List of ReimbursableDrugs web macyBureau:(518) 4863209NYS DOH Medicaid Pharmacy Program web page:http://www.health.ny.gov/health care/medicaid/program/pharmacy.htmSpecial Edition: Pharmacy Carve-Out New York State Medicaid Updatepg. 11
ProviderEnrollmentPricing, Lost ationand Pharmacy,DME, etc.) andBillingGuidelinesThe ProviderManuals tabhas billing andpolicy relatedguidance. Forexample:billingguidelines,procedurecodes, feeschedules, etc.for eachprovider type.ProviderOutreach andTrainingProviders mayvisit thetrainingwebsite veMedNYSupport:(800) 3439000, �s Provider Enrollment and Maintenancehome page index.aspxeMedNY’s Provider Manuals web aspxeMedNY’s General Billing Guidelines web viders/index.aspxN/ATrainingeMedNY’s Provider Training web page:https://www.emedny.org/trainingSpecial Edition: Pharmacy Carve-Out New York State Medicaid Updatepg. 12
Appendix C: Member Fact SheetMember Fact SheetPlease use the Member Fact Sheet to provide members with the resources and information they needregarding the carve-out. A print-friendly version of the Member Fact Sheet is available in multiple languageson the eMedNY Member Medicaid Pharmacy Benefit web page at: ***************************************Special Edition: Pharmacy Carve-Out New York State Medicaid Updatepg. 13
Provider DirectoryOffice of the Medicaid Inspector General:For suspected fraud or abuse complaints/allegations, call 1-877-87FRAUD, (877) 873-7283, or visit Office ofMedicaid Inspector General (OMIG) web site at: www.omig.ny.gov.Provider Manuals/Companion Guides, Enrollment Information/Forms/Training Schedules:Please visit the eMedNY website at: www.emedny.org.Providers wishing to listen to the current week’s check/EFT amounts:Please call (866) 307-5549 (available Thursday PM for one week for the current week's amount).For questions about billing and performing MEVS transactions:Please call the eMedNY Call Center at (800) 343-9000.Provider Training:Please
March 2021 Volume 37 Number 4 Medicaid Pharmacy Carve-Out Special Edition – Part Two Effective May 1, 2021, Medicaid members enrolled in mainstream Medicaid Managed Care (MC) Plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plans (SNPs) will receive their pharmacy
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