Medicaid in Education Alert
New York State Department of Health (DOH), Office of Health Insurance Programs (OHIP)
New York State Education Department (NYSED)
Preschool/School Supportive Health Services Program (SSHSP)
Medicaid in Education

Issue #19-01

To: All SSHSP Medicaid Providers
From: NYS DOH OHIP SSHSP & NYSED Medicaid in Education Unit
Date: January 24, 2019
Subject: DOH CIN Matching Project Implementation

The purpose of this Alert is to provide an update on the status of the eMedNY system project to help SSHSP providers acquire Client Identification Numbers (CINs) for their Medicaid-eligible students receiving SSHSP services in circumstances where other efforts to obtain CINs were unsuccessful.

eMedNY eligibility inquiry resources have been modified for SSHSP enrolled billing providers. Effective January 25, 2019, an SSHSP provider may submit an eligibility inquiry for a student utilizing the identifying demographics of a two-digit county code, along with the student name, birth date and gender code. The eMedNY system response will include the student’s Medicaid CIN when all demographic information exactly matches a single Medicaid member with coverage for the requested date of service. Accordingly, interim ad-hoc submissions of excel files with student demographic information will no longer be accepted. Files already submitted will be completed and results returned.

The new eligibility inquiry functionality is available in the free internet-based application ePACES, and in the batch and real-time 270/271 Health Care Eligibility Benefit Inquiry process through eMedNY eXchange. eMedNY eXchange is an access method used to submit HIPAA-compliant transactions to the eMedNY system via a web-based application.

These eligibility inquiry methods are available for SSHSP providers with ePACES access and an Electronic Transmitter Identification Number (ETIN). An ETIN is required to send and receive New York State Medicaid data electronically. An SSHSP provider may use their own ETIN/ePACES access, and/or authorize a contracted Medicaid service bureau to submit eligibility inquiries and/or claims on their behalf by certifying the service bureau’s ETIN, and recertifying that ETIN annually.

The Medicaid Eligibility Verification System (MEVS) Provider Manual has been updated and is available online. In addition, a new ePACES reference sheet with instructions about accessing the new functionality has been posted online.

The eMedNY Transaction Information Standard Companion Guide (CG) contains NYS Medicaid Specific information which may be used to develop the ASC X12 Health Care Eligibility Benefit Inquiry and Response (270/271). The Transaction Instruction component of the companion guide must be used in conjunction with an associated ASC X12 Implementation Guide. The instructions in the eMedNY companion guide are not intended to be stand-alone requirements documents.

Eligibility FAQs and generic 271 response sample are also available for review via the eMedNY HIPAA Support tab of the eMedNY website.

NYSDOH expects the Client Identification Number (CIN) on all Eligibility Inquiries submitted to eMedNY. In the absence of a CIN, NYSDOH expects SSHSP providers who are creating their own software and submitting via ASC X12 270/271 to enter the County Code in:

Loop 2100C (Subscriber Name) REF Segment

  • REF01 = “N6” (Plan Network Identification Number) qualifies county code
  • REF02 will contain the Client’s County Code

Once a subscriber CIN is located, it must be the Subscriber identifier submitted on all subsequent Eligibility Inquiries to eMedNY. Do not use student demographics and county code for eligibility inquiries when the CIN is known.

New Possible Causes for the following HIPAA Reject Codes

  1. HIPAA Reject “41”- (AUTHORIZATION/ACCESS RESTRICTIONS): The provider is not authorized to access the eMedNY system to perform a county code name search eligibility inquiry. This means that the new county code name search eligibility transaction is allowed for SSHSP enrolled providers ONLY.
  2. HIPAA Reject “75”- (SUBSCRIBER/INSURED NOT FOUND): An SSHSP enrolled provider submitted a county code name search eligibility transaction for which either:
    • No exact match is found.
    • Multiple Client IDs are found to be an exact match.
    • The county code that has been entered is invalid.

To enable confirmation of SSHSP provider/Medicaid Service Bureau updates to 270/271 file exchanges, the provider test environment has been updated with the new functionality for SSHSP provider eligibility inquiries. County/District two-digit codes used by eMedNY to identify the Medicaid member’s county of fiscal responsibility are listed in the MEVS Provider Manual, and were included in Medicaid Alert 18-08. School districts and counties are reminded that, in accordance with the Family Educational Rights and Privacy Act (FERPA), they may only submit eligibility inquiries with parental consent to access the parent’s or student’s public benefits or insurance for the first time pursuant to the Individuals with Disabilities Education Act (IDEA).

The billing window for SSHSP services rendered on and after July 1, 2017, was temporarily extended to the current 21 months as noted in Medicaid Alerts 18-02 and 18-08. We expect this temporary extension to be revised, and establish a timetable to resume a 12-month billing window, following review of implementation for this new functionality. Notice will be provided to school districts, counties and contracted Medicaid service bureaus in a new Medicaid Alert.

If you have any questions or comments regarding this Alert, please contact the NYS Department of Health at (518) 473-2160 or

Last Updated: January 24, 2019