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Question: How can providers check if their Medicaid enrollment application is in process and how Medicaid Managed Care plans determine which providers are in compliance with the 21st Century Cures Act?

Answer:  Pursuant to a 21st Century Cures Act Section 5005, no later than 7/1/2018, Managed Care Organizations (MCOs) must amend contracts with providers to include a provision that requires providers to enroll with the State’s Medicaid program. If, however, the providers fail to enroll, such providers shall be terminated from participating as a provider in any network of the MCO that serves individuals eligible to receive Medicaid and Child Health Plan (CHP) benefits.

At this time, MCOs should not be initiating terminations due to failure to enroll in NYS Medicaid.

The Pending Provider file will be updated bi-monthly, on approximately the 1st and 15th day of each month. The Pending Provider Listing is located on the eMedNY website.

< p>Pending Provider Listing file reflects providers who have submitted an application to NYS Medicaid, but a decision has not been made and they are not enrolled. Managed Care Organizations (MCO's) can review this data set to determine which providers have submitted applications but are not yet enrolled in Medicaid.

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Insights
May 2018