Welcome to the Optum Network!
21st Century Cures ACT
- The 21st Century Cures Act (Cures Act) 114 P.L. 255 requires all States to screen and enroll all Medicaid providers, both those in Medicaid fee-for-service (FFS) and managed care organizations (MCOs). Medicaid managed care network providers, regardless of specialty, are required to be screened by and enrolled with the State Medicaid Agency. Federal laws enforced by CMS, including the Affordable Care Act and the 21st Century Cures Act, require states to screen and enroll all providers. Providers who do not comply with this requirement risk being removed from the New York Medicaid managed care network.
- Beginning September 1,2022 providers who are not enrolled in NY Medicaid will no longer be eligible for payment of claims. The Medicaid provider enrollment process is to ensure appropriate and consistent screening of providers and improve program integrity. In order to enroll, you will need to go to Provider Index and navigate to your provider type to print and review the instructions and enrollment form. Here, you will also find a Provider Enrollment Guide and How Do I Do It? resource guide. FAQ Guide eMedNY.org
COVID-1- Guidance Udpates
Provider Notification
- Optum: New vendor for Employee Medical Health of Suffolk County (EMHP)
- Legislative changes for inpatient OMH & OASAS-Certified Providers
- NY Executive Order No. 4 & Circular Letter No. 1.
- Participating Provider Laboratory
and Pathology Protocol - Aug 2016
Optum Network Manual
Clinical Criteria
Best Practice Guidelines
Coordination of Care (COC)
Provider Contract Provisions and Compliance Requirements
- Coming soon
Mandates
New York Medicaid Provider Resources - Adults
Quality Improvement
NY Medicaid Audit Tools
- Case Management Record Audit Tool
- Clubhouse Site Audit Tool
- HCBS Record Review Tool
- Home office Audit Tool
- Individual Clinician Site Audit Tool
- MAT Program Site Review Tool
- NY SUD Treatment Record Tool
- NY Treatment Record Tool
- Organizational Provider Site Audit Tool
- Peer Support Audit Record Tool
- Peer Support Site Audit Tool
- Psychosocial Rehababilitation Site Audit Tool
Clinical Information
- Evidence Based Practice Quick Reference Guide
- HCBS Workflow: Level of Service (LOS) Determination Request and HCBS Plan of Care Submission
- Instructions for ECG Quick Connect for HH CMAs
- Notification and Concurrent Review Protocol Related to 2017 SUD Legislation
- NY Adult HARP Clinical Practice Guidelines
- NYS DOH AIDS Institute: HIV Clinical Guidelines Program
- Provider Training Curriculum Quick Reference Guide
- UnitedHealthcare-Approved Professional Society Guidelines
Prior Authorization and Notification (PAAN)
New York Child Health Plus
General Information
Coming soon
New York Medicaid Advantage Plus (MAP) Dual Complete One
New York Medicaid Provider Resources - Children Under 21
Provider Notifications
- Provider Notice of Under 21 Medicaid Service Implementation for January 2019
- Provider Notice of Under 21 Medicaid Service Implementation for July 2019
- Provider Notice of SED Clinic Services Carve-in for Under 21 Medicaid Members for July 2019
- PAAN Provider Alert
- Provider Notification of HCBS Implementation for Under 21 Medicaid Members for October 2019
- HCBS Provider Authorization for Under 21 Medicaid Members
- HCBS Language Assistance Services
- Provider Notice of Mobile Crisis Benefit for October 2019
- Provider Notice of Under 21 Medicaid Service Implementation for January 2020
Center for Practice Innovation (CPI)
- Provider Alert for CPI Provider Training
- CPI Children’s Uniform Clinical Network Provider Training
- NY Children and Family Treatment and Support Services End-to-End (E2E) Claims Testing
29i Health Care Facilities/VFCA Resources
Quick Reference Guide
Transmittal Form
Provider Training
Provider Notifications
- Foster Care Network Provider Letter January 2022
- Invitation to Claims Testing for 29-I Health Care Facilities/VFCA
Claims Testing Resources
Evidence Based Practice Guidelines
Additional information and forms are available, including psych/neuropsych testing guidelines, credentialing plans, and Disability Solutions Manual, on the Provider Express Guidelines/Policies & Manuals and Optum Forms pages.