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 #19-03

To: All SSHSP Medicaid Providers
From: NYS DOH OHIP SSHSP & NYSED Medicaid in Education Unit
Date: August 1, 2019
Subject: eMedNY modification for SSHSP attending provider claim editing

The purpose of this Medicaid Alert is to advise SSHSP providers of the eMedNY system modification to claim edit 00941 (service provider excluded prior to service/order date) reported on remittance advice reports with claim adjustment reason code B7. As you are aware, SSHSP attending providers (i.e. servicing therapists, nurses, and social workers) do not need to be Medicaid enrolled billing or OPRA (ordering/prescribing/referring/attending) providers.

Beginning on July 26, 2019 the SSHSP attending provider’s inactive Medicaid enrollment status will no longer cause claims to be denied. SSHSP attending providers do not need to have their own active Medicaid Management Information System (MMIS) number. SSHSP attending providers need to be currently licensed and registered by NYSED and have their license number and NPI affiliated with the billing provider(s) in eMedNY (Alert #12-02). The Department of Health (DOH) has and will continue to identify the claims that were incorrectly denied and have them reprocessed through eMedNY on the districts and counties behalf. The DOH anticipates reprocessing of claims to be completed by September 30, 2019.

It is important to note that this eMedNY system modification will not affect ordering/referring Medicaid enrollment requirements or eMedNY editing of ordering/referring provider NPI/license reported on Medicaid claims. Ordering and referring providers (e.g. physician, nurse practitioner, speech language pathologists) must be Medicaid enrolled or payment for services will be denied. Billing providers can access a database of Medicaid enrolled providers to verify an ordering/referring provider’s Medicaid enrollment status. This enrollment data can be accessed online at:

If you have any questions or comments regarding this Alert, please contact the NYS Department of Health at (518) 473-2160 or, the NYS Education Department, Medicaid Unit at, or your local Regional Technical Support and Assistance Contact.

Last Updated: August 5, 2019