Self-Disclosure Full Statement or Statement of Damaged, Lost or Destroyed Records Submission Method: OMIG's Hightail Secure Uplink site
(Note: To submit a Self-Disclosure Abbreviated Statement, follow the instructions on the form.)
To submit a completed Self-Disclosure using OMIG's Hightail Secure Uplink site, please follow the steps below:
1. Visit OMIG’s Hightail Secure Uplink site.
2. Select and drag the completed Self-Disclosure Statement as well as any attachments (including the completed Certification Form and any applicable spreadsheets or additional documentation) from your saved location to the Hightail uplink window or use the “ADD FROM MY COMPUTER” button on the Hightail site.
3. Include the following information in the Hightail message section:
- Your Name
- Your Email address
- Message – please include the name of the entity disclosing
4. Click on the “UPLOAD” button on the Hightail site
Your form and attachments will be securely uploaded to OMIG’s Hightail Secure Uplink site. Upon successful submission of the form and attachments, you will receive a confirmation email, which will include a link to access any uploaded files and attachments.
Additional information about Hightail and HIPAA Compliance.
To submit a Self-Disclosure by mail:
Please provide a completed Self-Disclosure Statement, Certification, any additional documentation, and include the Claims Data File on CD or another secure device.
Office of the Medicaid Inspector General
Attention: Self-Disclosure Unit
800 North Pearl Street
Albany, NY 12204
Please contact OMIG's Self-Disclosure Unit by email ([email protected]) or by phone (518-402-7030).