Medicaid Enrollment Requirements and Compliance Deadlines for Managed Care Providers

It was earlier stated in the January 2018 issue of the Medicaid Update article titled Medicaid Managed Care and Children’s Health Insurance Program Network Providers Must Enroll in the New York State Medicaid Program, §5005(b)(2) of the 21st Century Cures Act and 42 CFR §438.602 that all Medicaid Managed Care (MMC) network furnishing, ordering, prescribing, referring and attending (OPRA) providers be enrolled with the New York State (NYS) Medicaid program. Also, per 42 CFR §438.206(b)(4), MMC Plans will limit out-of-network services to services that could not be provided by network providers.

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