News

Integra Software has been acknowledged by New York State as -compliant for the direct billing of Medicaid dental claims to the State for both private practices (EDI 837D transaction) & institutional providers (EDI 837I transaction).

With direct billing, no clearinghouse or per-claim submission charges are involved - You save time and money!
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New York State Medicaid News for Dental Providers

CMS Announces a Discretionary Enforcement Period for 5010 Compliance

On November 17, 2011 the CMS Office of E-Health Standards and Services announced it would not enforce compliance with Version 5010 until 90 days after the January 1, 2012 compliance date.

New York Medicaid will follow the discretionary enforcement guidelines announced by CMS. For the period of January 1, 2012- March 31, 2012 Medicaid will continue to operate a dual system, accepting and processing HIPAA Versions 4010 and 5010.

Dental*Partner Supports the X12 5010 EDI Standard
DP is fully compliant with the X12 5010 version for all its current transaction sets: 837D, 277, 997, 999. January 1, 2012 has been the mandatory compliance date for electronic healthcare transactions. Medicaid began accepting claim submissions in the 5010 format on July 21, 2011.

In addition to 5010 billing, Dental*Partner reads and reports on Medicaid's technical "R"esponse files which are delivered to the provider's eMedNY xChange Inbox and are otherwise not readable.

Dental*Partner also updates your claims with Medicaid's claim pre-adjudication acceptance or edit codes + edit reasons found in the 277 response file, thus, greatly facilitating claim tracking and resubmissions, through Dental*Partner, when needed.
Billing Providers - Annual Recertification is Required!

If you bill electronically, you must get recertified annually or your claims will be rejected. The certification process links the provider’s NPI to the Electronic Transmitter Identification Number (ETIN) under which electronic claims are submitted.

Click here for more information. Also see our Information Links at page bottom.

Electronic Claims Submission Requirements - Getting Started

To submit Medicaid claims directly to the State, you must have an ETIN number (obtainable from Provider Services) as well as a eMedNY login user ID and password to access the eMedNY eXhange website where you upload your claim files. You must also contact Provider Services to activate your Inbox. See below. Login to the xChange at http://www.eMedNY.org to upload your files. Dental*Partner Help contains detailed instructions with screenshots for submitting claim files to Medicaid.

If you are already enrolled in ePACES, then you are already enrolled for eMedNY eXchange, and can activate your inbox by calling (800) 343-9000. If you are not enrolled in ePACES, you must enroll in the eXchange via https://www.emedny.org/enroll. You will be issued a user identification number and an initial password. Then call eMedNY Provider Services at (800) 343-9000 to activate your eMedNY eXchange Inbox.

National Provider ID (NPI)

Effective September, 2009, Medicaid made NPI mandatory for all dental claim submissions.

How to Obtain Your NPI - The fastest method is to log onto the National Plan and Provider Enumeration System (NPPES) and apply online at https://nppes.cms.hhs.gov.

Registering Your NPI with NYS Medicaid - Once you get your NPI, you must register it with the State. Go to http://www.eMedNY.org and clicking on "Enter NPI" located in the green box on the right of the screen, or click on this link https://npi.emedny.org/. All NPI's should be registered as soon as possible so NYSDOH can link provider IDs with NPIs in their claims & remittance systems.

The latest information on NPIs can be found on the eMedNY website. To find out more about how to obtain an NPI, visit www.cms.hhs.gov/NationalProvIdentStand.

Emergency Services

Billing for patients eligible to receive 'Emergency Services Only' is limited to specific procedure codes. Click here for a list of codes and information on billing for these services.

Prior Approval Required for for Orthodontic Services in upstate counties

Click here for more info.