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Weekly Provider Tips for June 12, 2017


For new UHC/Oxford children, providers/Service Coordinators should send the IFSP, along with the subrogation notice to the payers. UHC/Oxford uses the IFSP to determine medical necessity. IFSPs can also be uploaded via the UHC/Oxford’s online portal, using the Claim Reconsideration Request tool. Uploading the IFSP via the payer’s online portal also provides a record of IFSP submission that is traceable.

OPRA Status

Please remember to confirm that your referring provider is enrolled with Medicaid prior to rendering services at:

Providers should check twice a year to ensure that a referring provider is still enrolled as an OPRA provider with Medicaid.

Revalidation vs. Recertification

Recertification is done annually and is related to claims processing.

Revalidation is done every five years to revalidate enrollment with Medicaid. Federal regulation 42 CFR 455.414 requires that Medicaid terminate a provider’s enrollment for failure to revalidate.

To Revalidate:

1. Visit the Provider Enrollment page at, locate your enrollment form and additional required documentation, and determine whether an enrollment fee is required. There is a slide presentation, step-by-step processes, and an FAQ section. These resources provide important information on the revalidation process.

2. Complete and mail the appropriate form(s) with all required documentation to the address provided. Keep a copy of the forms and documentation.

If you have additional questions, please contact the eMedNY Call Center at 800-343-9000 and select Option 2.

Article ID: 357, Created On: 6/9/2017, Modified: 6/9/2017

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