Reminder: Medicaid Attestation Required for New York State Medicaid Members Enrolled in Qualifying Clinical Trials

IMMEDIATE ACTIONS (Before January 1, 2027): 1) Billing team must reprogram billing software and prior authorization submission workflows to enforce new 7-day standard PA timelines and 72-hour expedited PA timelines for NYS Medicaid FFS members. Update automated PA decision tracking to alert staff if requests exceed new timeframes. 2) Providers must enroll in ePACES and eMedNY eXchange if not already enrolled to enable real-time claim submission and real-time PA status tracking; verify enrollment using credentials found on eMedNY ePACES Enrollment document. 3) Billing team must update encounter forms and documentation checklists to ensure all PA requests include complete necessary documentation to avoid denials due to missing information. 4) For breast cancer imaging: Update billing protocols to remove all cost-sharing/patient responsibility for CPT codes 77065, 77066, 77067, and 77063 when billed to NYS Medicaid for qualifying patients (per coverage guidelines). Ensure billing software flags these codes for no out-of-pocket verification. 5) Train billing and prior auth staff on new PA denial rules: if requested information is not submitted within the extended 14-day window, the PA will be automatically denied. CONSEQUENCES: Failure to update workflows will result in PA denials after 7-14 days; incorrect cost-sharing on breast cancer imaging will trigger compliance issues with NYS Department of Health. CONTACT: For billing questions, call eMedNY at (800) 343-9000; for policy questions, email OHIPMedPA@health.ny.gov or call (800) 342-3005.