Posted in MVP (NY/VT) Insurance Payer, Pharmacy (Various Insurance Payers), Training, Updates

NY Managed Medicaid Plans Reimbursement Update: Pharmacies 05/01/2021

Starting 05/01/2021– The prescriptions will no longer be covered and paid under the Managed Medicaid Plans (ei. MVP). Instead the prescriptions will be covered under NY Medicaid Fee for Service Fee Schedule.

Where can I find the list of covered medications?

  1. Medicaid Fee for Service has a list of covered medications. OTC (over the counter medications and most other medications are on that list. The list can be found on emdNY website.
  2. Medicaid Fee for Services also has a preferred medication list. This list can be found by clicking here.

Do I have to participate in NY Medicaid Fee for Service?

As a pharmacy (provider) you will need to participate in NY Medicaid Fee for Service, in order to fulfill the Managed Medicaid Patient RXs.

What else do I need, in order to process claims?

A Managed Medicaid Member has to show you their NY Medicaid Card or your Health Plan Card. As a Participating Pharmacy Provider you will need the CIN number in order to file your claims.

For General Information and Updates please click here.

Author:

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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