NEW YORK MEDICAID HIPAA TRANSACTION GUIDES by LeeGreenwood

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									                                   NEW YORK MEDICAID
                                HIPAA TRANSACTION GUIDES

Use this table to verify which 837 / NCPDP Companion Guide is used to submit claims to New York
Medicaid for the category(s) of service (COS) that was assigned by New York State Department of
Health at the time of your enrollment in the Medicaid Program. The last column depicts, in
numerical order, all Medicaid COS. To the left, find the 837 Transaction Guide that corresponds to
your COS.


                                                                                 Ca te gory
                                                                 Tra nsa ction        Of
     PROVIDER TYPE                                                   Type         S e rvice
     CHAIN PHARMACY                                                NCPDP            0000
     CHAIN DME DEALER                                         PROFESSIONA L         0001
     CHAIN NURS ING REGIS TRY                                 PROFESSIONA L         0002
     SHARED HE ALTH FACILITY                                  PROFESSIONA L         0010
     DENTA L GROUP                                                 DENTA L          0020
     PHYS ICIAN GROUP                                         PROFESSIONA L         0046
     PODIA TRIS T GROUP                                       PROFESSIONA L         0050
     NURS E-MIDW IFE GROUP                                    PROFESSIONA L         0052
     CLINICAL S OCIAL W ORKER GROUP                           PROFESSIONA L         0056
     CLINICAL P SY CHOLOGIST                                  PROFESSIONA L         0058
     THE RA PY GROUP SE RV ICE S                              PROFESSIONA L         0062
     MULTI TY PE GROUP SERV ICES                              PROFESSIONA L         0090
     CHILD CARE A GENCIES -MEDICA L PE R DIEM                  INSTITUTIONA L       0121

     CHILD CARE A GE NCIES -NOT ME DICAL PE R DIEM             INSTITUTIONA L       0122
     RE SIDENTIA L TRE ATME NT FA CILITY                       INSTITUTIONA L       0123
     CHIROPRACTIC S ERVICE S                                  PROFESSIONA L         0140
     DIA GNOSTIC & TRE ATME NT CENTER SV C                     INSTITUTIONA L       0160
     DA Y TREA TMENT                                           INSTITUTIONA L       0160
     CLINIC PHARMACY                                              NCPDP             0161
     LAB ORATORY ORDERED A MBULA TORY                          INSTITUTIONA L       0162
     LAB ORATORY ORDERED A MBULA TORY                         PROFESSIONA L         0162
     ORDERED AM B ULA TORY (OTHER THA N LA BS )                INSTITUTIONA L       0163
     ORDERED AM B ULA TORY (OTHER THA N LA BS )               PROFESSIONA L         0163
     SUPPORTIVE HEALTH SERVICES/EARLY
     INTERV ENTION                                            INSTITUTIONA L        0164
     HOS PICE                                                 INSTITUTIONA L        0165
     PRE-S CHOOL S UPPORTIV E HLTH P RG                       INSTITUTIONA L        0166
     DENTA L SCHOOL CLINIC SE RVICES                             DENTA L            0180
     DENTA L SE RVICES                                           DENTA L            0200
     CA PITA TION PROV IDE R                                  INSTITUTIONA L        0220
     HOME HE ALTH AGENCY                                      INSTITUTIONA L        0260
     HHA ME DICAL/S URGICAL S UP PLY AND DME
     EQUIP MENT                                               PROFESSIONA L         0261
     TRAUMA TIC B RAIN INJURY                                  INSTITUTIONA L       0263
     VE NDOR P ERSONA L CA RE SE RV ICE S                      INSTITUTIONA L       0264
                                                              Category
                                                                 Of
PROVIDER TYPE                              Transaction Type    Service
LIMITED LICENSED HOME CARE SERVICES         INSTITUTIONAL       0264
CASE MANAGEMENT SERVICES                    INSTITUTIONAL       0265
PERSONAL EMERGENCY RESPONSE SVC             INSTITUTIONAL       0266
ASSISTED LIVING PROGRAM                     INSTITUTIONAL       0267
OHM REHABILITATIVE SERVICES                 INSTITUTIONAL       0268
OMRDD WAIVER SERVICES                       INSTITUTIONAL       0269

LABORATORY (HOSPITAL-BASED) ORDERED AMB. INSTITUTIONAL         0281

LABORATORY (HOSPITAL-BASED) ORDERED AMB.   PROFESSIONAL        0281
ORDERED AMBULATORY OTHER THAN LABS         INSTITUTIONAL       0282
ORDERED AMBULATORY OTHER THAN LABS         PROFESSIONAL        0282
HOME CARE PROGRAM                          INSTITUTIONAL       0284
INPATIENT                                  INSTITUTIONAL       0285
SKILLED NURSING FACILITY                   INSTITUTIONAL       0286
HOSPITAL BASED OUTPATIENT SERVICES         INSTITUTIONAL       0287
DAY TREATMENT                              INSTITUTIONAL       0287
PHARMACY                                       NCPDP           0288
DURABLE MEDICAL EQUIPMENT                  PROFESSIONAL        0321
HEARING AID DISPENSER                      PROFESSIONAL        0322
OXYGEN AND RELATED EQUIPMENT DEALER        PROFESSIONAL        0323
AUDIOLOGIST/HEARING AID DEALER             PROFESSIONAL        0324
AUDIOLOGIST                                PROFESSIONAL        0325
SKILLED NURSING FACILITY                   INSTITUTIONAL       0381
DAY CARE                                   INSTITUTIONAL       0383
INTERMEDIATE CARE
FACILITY/DEVELOPMENTALLY DISABLED          INSTITUTIONAL       0384

MENTAL RETARDATION, OUTPATIENT SERVICES    INSTITUTIONAL       0385
HHA PROF. SERVICES                         INSTITUTIONAL       0386
LONG TERM HOME HEALTH CARE                 INSTITUTIONAL       0388
ORDERED AMBULATORY (NURSING HOME
BASED)                                     PROFESSIONAL        0389
OPTICAL ESTABLISHMENT WITH SALARIED
OPTOMETRIST                                PROFESSIONAL        0401
OPTICAL ESTABLISHMENT WITHOUT SALARIED
OPTOMETRIST                                PROFESSIONAL        0402
OPTICIAN (OPHTALMIC DISPENSER) SALARIED    PROFESSIONAL        0403
OPTICIAN (OPHTALMIC DISPENSER) SELF -
EMPLOYED                                   PROFESSIONAL        0404
EYE PROSTHESIS FITTER                      PROFESSIONAL        0405
EYEGLASS MATERIALS - UPSTATE               PROFESSIONAL        0407
OPTOMETRIST (SALARIED)                     PROFESSIONAL        0421
OPTOMETRIST (SELF EMPLOYED)                PROFESSIONAL        0422
OPTOMETRIST WHO EMPLOYS OTHER
OPTOMETRISTS OR AN OPTICIAN                PROFESSIONAL        0423
DRUGS                                         NCPDP            0441
                                                         Category
                                                            Of
PROVIDER TYPE                           Transaction Type Service
PHARMACY MEDICAL SUPPLIES, EQUIPMENT AND
APPLIANCES                               PROFESSIONAL     0442
PHARMACY HEARING AID DISPENSER           PROFESSIONAL     0443
SUPERVISING PHARMACIST                      NCPDP         0444
PHYSICIAN SERVICES                       PROFESSIONAL     0460
CHAP PRAC                                PROFESSIONAL     0461
PHYSICIANS ASSISTANTS                    PROFESSIONAL     0462
HIGH ORDERING PROV                       PROFESSIONAL     0463
NURSE PRAC                               PROFESSIONAL     0469
PODIATRY SERVICES                        PROFESSIONAL     0500
LPN                                      PROFESSIONAL     0521
RN                                       PROFESSIONAL     0522
HOSPITAL REGISTRY LPN                    PROFESSIONAL     0523
HOSPITAL REGISTRY RN                     PROFESSIONAL     0524
NURSE-MIDWIFE GROUP                      PROFESSIONAL     0525
CLINICAL SOCIAL WORKER SERVICES          PROFESSIONAL     0560
CLINICAL PSYCHOLOGY SERVICES             PROFESSIONAL     0580
AMBULANCE                                PROFESSIONAL     0601
INVALID COACH                            PROFESSIONAL     0602
TAXI                                     PROFESSIONAL     0603
TRANS-MEDICAL/SURGICAL SUPPLIES          PROFESSIONAL     0604
LIVERY SERVICES                          PROFESSIONAL     0605
TRANS DAY TREATMENT                      PROFESSIONAL     0606
TRANSPORTATION (OTHER)                   PROFESSIONAL     0609
OCCUPATIONAL THERAPIST                   PROFESSIONAL     0621
PHYSICAL THERAPIST                       PROFESSIONAL     0622
SPEECH PATHOLOGIST                       PROFESSIONAL     0623
LABORATORY (FREE STANDING)               PROFESSIONAL     1000
LABORATORY DIRECTOR                      PROFESSIONAL     1001

								
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