Welcome to the Optum Network!

21^st 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 21^st 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

• COVID-19 Updates on New York Clinical Procedure Changes

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

• Network Manual

Clinical Criteria

• Standard Clinical Criteria

Best Practice Guidelines

• BP Guidelines
• Telehealth Best Practices

Coordination of Care (COC)

• COC Flyer
• COC Checklist

Provider Contract Provisions and Compliance Requirements

• Coming soon

Mandates

• NY Early Intervention Billing

New York Medicaid Provider Resources - Adults

New York Medicaid Advantage Plus (MAP) Dual Complete One

New York Medicaid Provider Resources - Children Under 21