Unless otherwise required by law or contract, it is recommended that providers check the NYS Medicaid Exclusion List at least every 30 days as a best practice.
Use of this list will help providers avoid submitting claims for medical care, services, and/or supplies that are ordered or prescribed by individuals or entities who are not authorized to submit such orders. Enrolled providers should verify that the orderer has not been excluded before filling an order or prescription. If the orderer's or prescriber's name appears on the NYS Medicaid Exclusion List, Medicaid should not be billed for the care, services, or supplies ordered, prescribed, or provided by that person or entity.
Any claim submitted for medical care, services, or supplies ordered/prescribed by any individuals or entities appearing on the NYS Medicaid Exclusion List may be denied, and the enrolled provider dispensing prescriptions or filling orders may be held responsible for repayment of any payments made by the Medicaid program under these circumstances.
For orders or prescriptions requiring prior approval or prior authorization, it should be noted that the receipt of an approval or authorization is not a guarantee of payment. Payment is subject to a patient's eligibility and compliance with all applicable statutes and policies.