IFSPs
For new UHC/Oxford children, providers/Service
Coordinators should send the IFSP, along with the subrogation notice to the
payers. UHC/Oxford uses the IFSP to
determine medical necessity. IFSPs can also be uploaded via the UHC/Oxford’s
online portal, using the Claim Reconsideration Request tool. Uploading the IFSP
via the payer’s online portal also provides a record of IFSP submission that is
traceable.
OPRA Status
Please remember to confirm that your referring provider is enrolled
with Medicaid prior to rendering services at: https://www.emedny.org/info/opra.aspx
Providers
should check twice a year to ensure that a referring provider is still enrolled
as an OPRA provider with Medicaid.
Revalidation
vs. Recertification
Recertification
is done annually and is related to claims processing.
Revalidation
is done every five years to revalidate enrollment with Medicaid. Federal
regulation 42 CFR 455.414 requires that
Medicaid terminate a provider’s enrollment for failure to revalidate.
To Revalidate:
1. Visit the Provider Enrollment page at
www.emedny.org/revalidation, locate your enrollment form and additional
required documentation, and determine whether an enrollment fee is required.
There is a slide presentation, step-by-step processes, and an FAQ section.
These resources provide important information on the revalidation process.
2. Complete and mail the appropriate
form(s) with all required documentation to the address provided. Keep a copy of
the forms and documentation.
If you have additional questions, please
contact the eMedNY Call Center at 800-343-9000 and select Option 2.