Nys Social Services Medicaid Provider Agreement

If you are a social services provider in New York State, it is important that you understand the Medicaid Provider Agreement. This agreement outlines your responsibilities as a provider and the terms of your relationship with the New York State Department of Health.

The Medicaid program is a federal and state partnership that provides healthcare coverage to low-income individuals and families. In New York, the program is administered by the state Department of Health`s Division of Medicaid and Health Financing. To participate in the Medicaid program as a provider, you must sign a Medicaid Provider Agreement.

The agreement spells out the terms under which you will provide services to Medicaid beneficiaries, including the services you are approved to provide, the payment rates for those services, and the rules and regulations that govern your participation in the program.

Some of the key provisions of the Medicaid Provider Agreement include:

– Provider qualifications: To participate in the Medicaid program, you must meet certain qualifications, such as being licensed and registered to practice in New York State.

– Covered services: The agreement specifies the services you are approved to provide to Medicaid beneficiaries. This may include medical and dental services, prescription drugs, and supplies and equipment.

– Payment rates: The agreement outlines the payment rates for each service you provide, which may be set by the state or negotiated between you and the state.

– Claims submission: You must submit claims for payment in a timely manner and in accordance with state rules and regulations.

– Compliance with laws and regulations: You must comply with all applicable state and federal laws and regulations, as well as Medicaid program policies and procedures.

– Recordkeeping: You must maintain accurate and complete records of the services you provide to Medicaid beneficiaries.

By signing the Medicaid Provider Agreement, you agree to abide by all of these provisions and to participate in the Medicaid program in good faith. Failure to do so may result in sanctions, including termination from the program.

If you have questions about the Medicaid Provider Agreement or need assistance with the enrollment process, you can contact the New York State Department of Health`s Division of Medicaid and Health Financing.

In summary, the New York State Department of Health`s Medicaid Provider Agreement is a critical document for social services providers participating in the Medicaid program. It outlines the terms and conditions of your participation and sets out your obligations as a provider. By following these rules and regulations, you can ensure that you are providing high-quality care to Medicaid beneficiaries and contributing to the overall success of the program.


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