IMPORTANT NOTICE: PHARMACY BILLING GUIDANCE EXCEPTIONS FOR NON-ENROLLED PRESCRIBERS

The New York State (NYS) Medicaid program requires enrollment of all licensed prescribers and pharmacies who serve Medicaid members, including prescribing practitioners identified on pharmacy claims per the Centers for Medicare and Medicaid Services (CMS) and federal regulations. However, under the Medicaid Provider Enrollment Compendium (MPEC) found here: https://www.medicaid.gov/medicaid/program-integrity/affordable-care-act-program-integrity-provisions/index.html, there are two exceptions to the provider enrollment requirement that are allowed. Learn more here.