eMedNY NCPDP Batch Pharmacy Dial-Up User Manual
Contents
1. 12 0 1 13 0 INFORMATIONAL DOCUMENTS RETRIEVAL DOWNLOAD 13 0 1 14 0 ENVIRONMENT CONFIGURATION enne ennt ntn tntn ennt tn u 14 0 1 15 0 DISCONNECTING FROM eMedNY uuu 15 0 1 16 0 TROUBLE SHOOTING 16 0 1 17 00 FORMS P S 17 0 1 Certification Statement For Provider Utilizing Electronic Billing 17 0 2 Provider Electronic Transmission Identification Number ETIN Application 17 0 3 AGREEMENT for eMedNY System ACCESS 17 0 5 Provider Vendor eMedNY Access Request Form 17 0 8 December 2003 i Table of Contents NCPDP BATCH PHARMACY 1 0 DISCLAIMER Rev 12 03 Every effort will be made to ensure the information contained in this document is as accurate as possible However information in the document is subject to change without notice and does not represent a commitment on the part of New York State or Computer Sciences Corporation CSC Enhanced version s of this document will be available for retrieval downloading by accessing the New York State Medicaid Management Information System Electronic Gateway at CSC This manual will be available on the eMedNY org website at http2. www emedny org manuals index html Throughout this document various acronyms may be used to represent programs systems entities and other information Below is a cross reference table listing those acronyms Abbreviation Description EG Electronic Gateway NYS New York State CSC Computer Sciences Corporation ETIN Electronic Transmission Identification Number a k a TSN ECSS Electronic Claim Submission System MMIS Medicaid Management Information System MEDS Medicaid Encounter Data Set eMedNY New York State Medicaid System This document has been prepared to help facilitate the electronic submission of information to the eMedNY Contractor Any comments or suggestions associated with this document should be forwarded to the address listed below Computer Sciences Corporation Department Provider Services 1 CSC Way Rensselaer New York 12144 December 2003 1 0 1 Disclaimer NCPDP BATCH PHARMACY 2 0 INTRODUCTION Rev 12 03 The New York State Department of Health DOH has elected to provide Medicaid providers with the ability to submit data electronically to the Medicaid Management Information System MMIS eMedNY Contractor CSC The eMedNY Electronic Gateway and supporting systems offer additional benefits to providers taking advantage of this method of claim submission Listed below are a few of these benefits 1 Reduced or eliminated manual handling of claim media and or and related documents Because
3. That is all File Transmission Status File s Electronic Front End Response File s and any previously generated Download Log s will be transmitted to you You will be prompted to initiate your communication software s file transfer process with the following message Start your local KERMIT receive Once the file transfer is completed the eMedNY will generate a message similar to the following FILE TRANSFER SUCCESSFUL xx FILE S SENT December 2003 12 0 1 Electronic File Submission Download NCPDP BATCH PHARMACY All files generated by the eMedNY will be maintained by CSC for a limited time only therefore they should be retrieved as soon as possible to ensure availability Once retrieved the file s will be removed from the eMedNY and will not be available for subsequent retrieval An ECSS Download Log ECSS DWN is created each time a request is made to retrieve any files available through the ECSS RETRIEVE MENU The ECSS Download Log will be available through subsequent iterations of the ECSS RETRIEVE MENU All files transmitted to the eMedNY will be named with a Date Time stamp That is a file submitted to the eMedNY at 1 30 PM on October 05 2003 will receive the file name 031005133000 YYMMDDHHMMSS format As a result all subsequently generated information file s associated with the file will be named similarly For example the related File Transmission Status File and Electronic Front End Response File would be named
4. BE FROM FEDERAL STATE AND LOCAL PUBLIC FUNDS AND THAT 1 MAY BE PROSECUTED UNDER APPLICABLE FEDERAL AND STATE LAWS FOR ANY FALSE CLAIMS STATEMENTS OR DOCUMENTS OR CONCEALMENT OF A MATERIAL FACT taxes from which the State is exempt are excluded all records pertaining to the care services and supplies provided including all records which are necessary to disclose fully the extent of care services and supplies provided to individuals under the New York State Medical Assistance Program will be kept for a period of six years from the date of payment and such records and information regarding these claims and payment therefore shall be promptly furnished upon request to the local or State Departments of Social Services the State Medicaid Fraud Control Unit or the Secretary of the Department of Health and Human Services there has been compliance with the Federal Civil Rights Act of 1964 and with section 504 of the Federal Rehabilitation Act of 1973 as amended which forbid discrimination on the basis of race color national origin handicap age sex and religion agree or the entity agrees to comply with the requirement of 42 CFR Part 455 relating to disclosures by providers the State of New York through its eMedNY Contractor or otherwise is hereby authorized to 1 make administrative corrections to claims submitted under this agreement to enable its automated processing subject to reversal by the provider and 2 accept the claim under this agreement
5. ECSS is designed to accept only one file transfer at a time Multiple transfers within the same transmit session will not be successful Start your local XXXXXXX send You must then begin the file transfer process associated with your communication software Set your file transfer process to XXXXXXX where XXXXXXX is your defaulted file transfer selection Please refer to Section 14 0 for Environment Configuration section of this manual for further details associated with file transfer options Once the file transfer process is initiated many telecommunications software packages will generate some kind of file transfer status message The file transfer status generated will give you an indication of how the actual transfer is progressing Once the file transfer is completed the eMedNY will generate one of the file transfer messages listed below If the file transfer is successful and is in the correct format for further editing the following message will be displayed FILE TRANSFER SUCCESSFUL xxxxxxx RECORDS RECEIVED Please note that the above message does not mean that the records have been accepted into a processing cycle When the file transfer is successful and in the correct format further editing will be performed on the records which will generate a response file The response file contains the status of your claim submission after all pre processing editing is complete Files that successfully pass pre processing edits will be en
6. F031005133000 and R031005133000 respectively In addition all files available for retrieval may be suffixed with a 1 3 digit sequence number Using the example depicted above the File Transmission Status File and Electronic Front End Response File would be ultimately named F031005133000 1 and R031005133000 2 respectively The suffix or sequence number on the right of the decimal should provide file name uniqueness for your computer s operating system Once retrieved the files depicted above on a personal computer using the Disk Operating System DOS would appear as F0310051 1 and R0310051 2 respectively The file suffix or sequence number will be incremented by one until 999 is reached Once 999 is reached the sequencing will begin at 1 again Note Due to restrictions within Terminal for Windows Communication Software multiple files cannot be downloaded in one file transfer session Therefore users in a Windows environment may encounter difficulties when attempting to retrieve response and other files from the EG You may contact CSC s Provider Services Department at 800 343 9000 to check the status of these submissions December 2003 12 0 2 Electronic File Submission Download NCPDP BATCH PHARMACY 13 0 INFORMATIONAL DOCUMENTS RETRIEVAL DOWNLOAD Rev 12 03 Selecting the INFORMATIONAL DOCUMENTS option from the MAIN MENU will yield a screen similar to the following screen and additional related messages NEW YORK STATE M
7. be aware of and comply with the following rules regarding USERIDS and Passwords a USERIDS and Passwords must not be shared with anyone A USERID is assigned by CSC eMedNY Data Security solely to an individual and the individual is responsible for all system activity related to that USERID b After four consecutive password violations i e entering the wrong password the USERID is revoked If this occurs CSC eMedNY Data Security Administration intervention is required to reactivate the USERID Contact Provider Relations to activate this intervention have read and fully understand the USERID and Password rules as set out above Please provide a unique identifier which will be used to authenticate this Provider Vendor when corresponding via phone This identifier should be something only this Provider Vendor knows and will be used to verify that the Provider Vendor is who they indicate they are when we are asked to provide sensitive information such as account passwords Unique identifier By Provider Number Please print name Provider Vendor Name Signature Title Street Address Date City State Zip December 2003 17 0 10 Forms
8. s Provider Services for assistance 4 File transfers do not complete successfully e Check your communication software settings associated with file transfer protocol e The eMedNY will support incoming files transferred with Xmodem Ymodem Zmodem and Kermit Binary Outgoing files will be sent using the Kermit file transfer protocol only September 2003 16 0 1 Trouble Shooting NCPDP BATCH PHARMACY 17 0 FORMS Rev 12 03 The following forms are included in the manual Certification Statement For Provider Utilizing Electronic Billing Provider Electronic Transmission Identification Number ETIN application AGREEMENT for eMedNY System ACCESS December 2003 17 0 1 Forms NCPDP BATCH PHARMACY ETIN BILLING SERVICE NAME IF APPLICABLE MEDICAID MANAGEMENT INFORMATION SYSTEM CERTIFICATION STATEMENT FOR PROVIDER UTILIZING ELECTRONIC BILLING Rev 12 03 As of date all claims electronically submitted to the State s Medicaid eMedNY Contractor for services or supplies furnished by provider provider number will be subject to the following certification am or the business entity named in this form of which am a partner officer or director is a qualified provider enrolled with and authorized to participate in the New York State Medical Assistance Program and in the profession or specialties if any required in connection with this claim the persons providing services care and supplies have the necessary licensi
9. EDICAID MANAGEMENT INFORMATION SYSTEM ELECTRONIC GATEWAY eMedNY Tuesday July 29 2003 at 09 00 18AM INFORMATIONAL DOCUMENTS 1 HIPAA PDF 16000 2 HOSTS TXT 246 3 USERMAN HTM 56125 4 USERMAN WRI 51712 A ALL FILES X EXIT INFORMATIONAL DOCUMENTS ENTER FILE OPTION DESIRED The INFORMATIONAL DOCUMENTS retrieval facility provides an electronic mechanism for the distribution of eMedNY and related documents such as the files depicted above The screen depicts individual file information such as the associated file number 1 file name HIPAA PDF and the number of bytes or characters associated with the file The document retrieval facility allows the selection of individual files or all files Displaying the number of bytes per file will help facilitate calculating or projecting the required download time associated with the file s chosen and your hardware and software configuration You will be prompted to initiate your communication software s file transfer process with the following message Start your local KERMIT receive December 2003 13 0 1 Informational Documents Retrieval Download NCPDP BATCH PHARMACY Once the file transfer is completed the INFORMATIONAL DOCUMENTS retrieval facility will generate one of the following file transfer messages The exact message will vary slightly depending on whether the RETRIEVE ALL FILES option or a specific file is chosen FILE TRANSFER SUCCESSFUL xx FILE S S
10. ENT FILE TRANSFER SUCCESSFUL 1 FILE SENT An Informational Documents Download Log INFO DWN is created each time a request is made to retrieve any files available through the INFORMATIONAL DOCUMENTS MENU The Informational Documents Download Log will be available through subsequent iterations of the ECSS RETRIEVE MENU The file suffix or sequence number described in Section 12 0 will also be applied to the Informational Documents Download Log For example a retrieval request for one or more informational documents will result in an Informational Documents Download Log named INFO DWN 1 December 2003 13 0 2 Informational Documents Retrieval Download NCPDP BATCH PHARMACY 14 0 ENVIRONMENT CONFIGURATION The Environment Configuration option from the Main Menu is designed to facilitate selection of your preferred sending file transfer protocol As the following graphic depicts the eMedNY will support incoming file transfers in Kermit Binary Xmodem Ymodem and Zmodem protocols Due to Kermit s extensive error correction mechanisms all outgoing files sent from CSC to you will utilize the Kermit file transfer protocol until further notice NEW YORK STATE MEDICAID MANAGEMENT INFORMATION SYSTEM ELECTRONIC GATEWAY eMedNY Tuesday July 29 2003 at 09 03 46AM ENVIRONMENT CONFIGURATION SEND RECEIVE 1 KERMIT KERMIT 2 XMODEM KERMIT DEFAULT 3 YMODEM KERMIT 4 ZMODEM KERMIT X SAVE AND RETURN TO MAIN MENU ENTER OPTIO
11. N DESIRED Until altered the default sending and receiving file transfer protocols will be Kermit Select the desired file transfer protocol for sending files to CSC and return to the main menu when finished September 2003 14 0 1 Environment Configuration NCPDP BATCH PHARMACY 15 0 DISCONNECTING FROM eMedNY Disconnecting from the eMedNY is accomplished by entering an X on the ECSS MAIN MENU This action will log you off of the eMedNY and disconnect the telephone line September 2003 15 0 1 Disconnecting from the eMedNY NCPDP BATCH PHARMACY 16 0 TROUBLE SHOOTING 1 Unable to connect to the eMedNY or supporting systems e Make sure all communication software settings are appropriate for your personal computer and modem configuration For example has the correct serial port been selected etc e Refer to Section 5 0 Hardware and Software Requirements to ensure compliance eMedNY may be unavailable call CSC s Provider Services for assistance 2 Unable to login to the eMedNY e Check all user access key information User identifier and password information are case sensitive e Call CSC s Provider Services for assistance 3 Random characters showing up on the screen e Probably a bad connection Noise or static on the line can result in bad or unrecognizable characters being transmitted to the Host Disconnect and try again e Make sure your communications software is emulating a VT100 terminal e Call CSC
12. STATE OF NEW YORK ere DEPARTMENT OF HEALTH eMedNY NCPDP Batch Pharmacy Dial Up User Manual December 18 2003 Version 1 1 December 2003 Computer Sciences Corporation Federal Sector Civil Group NCPDP BATCH PHARMACY TABLE OF CONTENTS Section Page Nos jeu 1 0 1 2 0 INTRODUCTION mee m 2 0 1 2 1 Information u nennen nnn nnne nnn 2 0 1 3 0 eMedNY USER MANUAL NOTATION nne tntnen nnne tnmen tnn instan tn instan tnn 3 01 40 MANUAL REVISIONS ee eee ee es 4 0 1 5 0 HARDWARE AND SOFTWARE REQUIREMENTS eere 5 0 1 6 0 CERTIFICATION STATEMENT tenti cur anoaca coena cius itane n tain ep nace reae char sr acane 6 0 1 6 1 ETIN Application for new submitters 6 0 1 7 0 AVAILABILITY OF eModNY terreri uuu u u 7 0 1 80 ECSS FILE FORMATS SUPPORTED u uuu 8 0 1 9 0 OBTAINING AN eMedNY USER ACCESS 9 0 1 10 0 CONNECTING TO THE 10 0 1 11 0 ELECTRONIC FILE SUBMISSION UPLOAD 11 0 1 12 0 ELECTRONIC FILE RETRIEVAL DOWNLOAD
13. as original evidence of care services and supplies furnished In submitting claims under this agreement understand and agree that or the entity shall be subject to and bound by all rules regulations policies standards fee codes and procedures of the New York State Department of Social Services as set forth in title 18 of the Official Compilation of Codes Rules and Regulation of New York State and other publications of the Department including Medicaid Management Information System Provider Manuals and other official bulletins of the Department understand and agree that or the entity shall be subject to and shall accept subject to due process of the law any determinations pursuant to said rules regulations policies standards fee codes and procedures including but not limited to any duly made determination affecting my or my entity s past present or future status in the Medicaid program and or imposing any duly considered sanction or penalty UNDERSTAND THAT MY SIGNATURE HEREON THE ABOVE CERTIFICATION WILL APPLY TO ALL ELECTRONIC CLAIMS SUBMITTED USING MY OR THE ENTITY S MEDICAID PROVIDER IDENTIFICATION NUMBER THIS CERTIFICATION REMAINS IN EFFECT AND APPLIES TO ALL CLAIMS UNTIL SUPERSEDED BY ANOTHER PROPERLY EXECUTED CERTIFICATION STATEMENT Signature Date Typed Name and Title STATE OF COUNTY OF On this day of 20 before me personally came to me know and known to me to the individual described in an
14. bmit electronic magnetic media must first apply for an Electronic Transmitter Identification Number ETIN by completing a Provider Electronic Transmitter Identification Number Application and a Certification Statement for Provider Utilizing Electronic Billing which must be notarized Once signed and notarized the Certification Statement MUST be sent for each Provider to be enrolled under the ETIN If you are presently certified under Medicaid s current certification process there will be no need to recertify until your annual Certification renewal is due Please send the signed and notarized Certification Statement for Provider Utilizing Electronic Billing and the Provider Electronic Transmitter Identification Number Application to the following address Computer Sciences Corporation Attention EMC Control 1 floor 800 North Pearl Street Albany NY 12204 In past implementations the ETIN was known as TSN originally Tape Supplier Number and later Transmission Supplier Number Generally speaking this number is used to identify the entity communicating the transaction The ETIN is also used to determine to whom or where the remittance advice is to be sent Submitters wishing to use multiple ETIN s must have a Primary Electronic Transmitter Identification Number The check balancing information will be returned to the Primary ETIN More information on the selection process can be found on the website at https www hipaadesk co
15. ceptance to the terms and conditions of this Agreement 2 Complete the information requested at the bottom of the Agreement form and sign the Agreement Please print or type the following information a Provider Number Only for enrolled providers or vendors with an assigned Medicaid ID number Otherwise leave this field blank Enter your eight digit Medicaid Provider ID Number which was assigned by the Department of Health at the time of your enrollment in the Medicaid program b Provider Vendor Name Enter the name of the Provider Vendor that will be subject to the agreement If you have a Medicaid Provider ID enter the name associated with the Provider ID Number entered above C Street Address City State Zip Enter the address where you would like to receive correspondence from CSC Please note that it must be a Street Address not a P O Box d By Print the name of the authorized person who signs the Agreement e Title Print the title of the authorized person who signs the Agreement f Date Enter the date on which the Agreement is signed December 2003 17 0 4 Forms NCPDP BATCH PHARMACY SECURITY PACKET B AGREEMENT for eMedNY System ACCESS Rev 12 03 WHEREAS the New York State Department of Health the Department and Computer Sciences Corporation CSC have entered into an agreement whereby CSC provides direct electronic access to MEDICAID eligibility verification claims submission and other electr
16. com e National Council for Prescription Drug Programs NCPDP Companion Guide REQUEST e National Council for Prescription Drug Programs NCPDP Companion Guide RESPONSE December 2003 8 0 1 ECCS File Formats Supported NCPDP BATCH PHARMACY 9 0 OBTAINING AN eMedNY USER ACCESS KEY Upon completion and subsequent filing of the electronic certification statement you will be given two pieces of information The first is your user identifier and the second is your initial password You will be required to change your password when you access the eMedNY the first time Make sure you record your new password and store it in a secure place If you lose or forget any component of your access key or suspect an unauthorized person may have knowledge of your access key please call the CSC Provider Services Department immediately You are responsible for any action taken on behalf of your account Refer to Security Packet B containing the forms to obtain an eMedNY user access key September 2003 9 0 1 Obtaining an eMedNY User Access Key NCPDP BATCH PHARMACY 10 0 CONNECTING TO THE eMedNY Rev 12 03 Connecting to Electronic Gateway Phone Number 866 488 3007 Access Key User Identifier SUPPLIED BY CSC Password INITIALLY SUPPLIED BY CSC Note The assigned user identifier and password are case sensitive All sign on information must be entered exactly as assigned Once connected to the eMedNY EG you will be prom
17. d who executed the foregoing instrument and s he acknowledge to me that s he executed the same SEAL NOTARY PUBLIC December 2003 17 0 2 Forms NCPDP BATCH PHARMACY PROVIDER ELECTRONIC TRANSMISSION IDENTIFICATION NUMBER ETIN APPLICATION Rev 12 03 To apply for your Electronic Transmission Identification Number ETIN which is required in order to submit data electronically for processing by the New York State MMIS or eMedNY please complete the items below and forward along with a Certification Statement to ATTN MAGNETIC MEDIA LIAISON FIRST FLOOR CSC HEALTHCARE SERVICES 800 NORTH PEARL STREET ALBANY NY 12204 PLEASE NOTE If you are adding a new Provider ID Number to an existing Electronic Transmission Identification Number ETIN send ONLY the Certification Statement 1 PROVIDER 2 PRIVIDER ADDRESS STREET CITY STATE ZIP CODE 4 x M PPS E TELEPHONE NUMBER EXTENSION FAX Number 3 ADMINISTRATOR S NAME 4 CONTACT PERSON S NAME TELEPHONE NUMBER 5 MMIS PROVIDER NUMBER S NOT GROUP SIGNATURE OF PERSON S AUTHORIZED TO SIGN PROVIDER MAGNETIC INPUT TRANSMITTALS NAME PRINTED SIGNATURE TITLE DATE NAME PRINTED SIGNATURE TITLE DATE December 2003 17 0 3 Forms NCPDP BATCH PHARMACY SECURITY PACKET B AGREEMENT for eMedNY System ACCESS Instructions for Completion 1 Please read the Agreement Your signature indicates ac
18. e presented with subsequent screens appropriate for the action chosen Selecting the TRANSMIT UPLOAD FILE S option will yield the following screen and related messages NEW YORK STATE MEDICAID MANAGEMENT INFORMATION SYSTEM ELECTRONIC GATEWAY eMedNY Tuesday July 29 2003 at 08 49 47AM eMedNY TRANSMIT MENU 1 TRANSMIT PRODUCTION BATCH FILE 2 TRANSMIT TEST BATCH FILE X EXIT TRANSMIT MENU ENTER OPTION DESIRED December 2003 11 0 1 Electronic File Submission Upload NCPDP BATCH PHARMACY The eMedNY TRANSMIT MENU provides the capability of submitting claims for a processing cycle or for electronic front end testing When claims are submitted for production option 1 they enter the next available payment processing cycle Claims submitted for test option 2 enter the next available test processing cycle The test submission capability is designed to allow providers to test how accurately their information has been formatted and to provide minimal editing on the data transmitted prior to submitting in a processing cycle All files submitted will be processed by the electronic front end provided the file format is acceptable Please refer to Section 8 0 ECSS File Formats Supported for the appropriate electronic media specifications A File Transmission Status File will be generated for each file transferred to the ECSS This file will be prefixed with an F as the first character of the file name Please refer to S
19. ection 12 0 for further details of the ECSS file naming convention A subsequent Electronic Front End Response File will also be generated and returned to the eMedNY for each file that was in the correct format for editing PLEASE NOTE A RESPONSE FILE WILL ONLY BE GENERATED FOR FILES that are in the correct format for further editing The response file will be prefixed with an R as the first character of the file name 90 DAY LATE SUBMISSION REASON SELECTION NEW YORK STATE MEDICAID MANAGEMENT INFORMATION SYSTEM ELECTRONIC GATEWAY eMedNY Tuesday July 29 2003 at 08 49 47AM 90 DAY LATE SUBMISSION REASON SELECTION 1 LITIGATION 2 MEDICARE INSURANCE PROCESSING DELAY 3 MEDICAID ELIGIBILITY DETERMINATION 4 REJECTION DENIAL OF ORIGINAL CLAIM 5 ADMINISTRATIVE DELAY IN PRIOR APPROVAL 6 IPRO DENIAL REVERSAL 7 INTERRUPTED MATERNITY CARE SELECTED N NOT APPLICABLE X SELECT AND CONTINUE PROCESSING ENTER SELECTION December 2003 11 0 2 Electronic File Submission Upload NCPDP BATCH PHARMACY The 90 DAY LATE SUBMISSION REASON screen provides the capability of attaching a valid 90 day reason to the file submitted electronically Simply select one of the valid reasons or N for not applicable this is also the default value then press X to continue Once the production or test indicator has been selected you will be prompted to initiate your file upload transfer process with the message depicted below Please note the
20. enrolled in the New York State Medical Assistance Program Medicaid or the Vendor that supplies switch services to a group of providers Name If you are an individual Provider enter your last name first name and middle initial if any a If the Medicaid Provider ID number applies to a business i e Pharmacy DME Supplier Laboratory etc enter the name of the individual authorized to sign the eMedNY Access Request on behalf of the provider organization a If you are a Vendor enter the Company name Address Enter the address where you would like to receive correspondence from CSC Indicate Check the box only one box please that best indicate your user status If you check the box next to Other please explain Medicaid Provider ID only for enrolled providers or vendors with an assigned Medicaid ID number otherwise leave this field blank Enter your or your organization s eight digit Medicaid Provider ID Number which was assigned by the Department of Health at the time of enrollment in the Medicaid program Phone Number Enter the phone number at which you can be contacted 2 Alternate Access Required Enter the reason for which you are requesting access to eMedNY 3 Requestor Information Requestor s Name Enter the name of the authorized person requesting access to eMedNY Date Enter the date on which the request was completed Phone Number Enter the phone number at which CSC can contact you if necessa
21. ent necessary to link Provider s Vendor s system to the eMedNY System Provider Vendor will be responsible for monitoring diagnosing and establishing dial backup on the telecommunication lines and equipment CSC does not provide consultation services beyond simple installation troubleshooting For example we cannot assist with the installation of the operating system or configuration issues involving the Provider s Vendor s LAN PC modem or printer CSC does not support Provider Vendor hardware or software When CSC provides the State of New York Medicaid Eligibility software the software is supplied AS IS AND CSC MAKES NO REPRESENTATIONS OR WARRANTIES EXPRESSED OR IMPLIED WITH RESPECT TO THE SOFTWARE In no event shall CSC be responsible for any damage to Provider s Vendor s property which arises out of or is related to Provider s Vendor s use of the Medicaid Eligibility claims submission and other electronic transaction software For qualified Providers Vendors CSC will provide support for the Medicaid Eligibility claims submission and other electronic transaction software supplied by CSC so long as CSC is the State of New York eMedNY contractor and Provider Vendor has not altered or modified the software in any way December 2003 17 0 6 Forms NCPDP BATCH PHARMACY PROVIDER VENDOR eMedNY Access Request Form Instructions for Completion Please type or print all required information 1 User Information User is the Provider
22. m nymedicaid A Primary ETIN selection form can be found there You will only need to fill out this form if you have multiple ETINs Please fill out the form and return to Computer Sciences Corporation Attention EMC Control 1 floor 800 North Pearl Street Albany NY 12204 September 2003 6 0 1 Certification Statement NCPDP BATCH PHARMACY 7 0 AVAILABILITY OF eMedNY Rev 12 03 The eMedNY system is available 24 X 7 In the event of a system problem you may call CSC s Provider Services Department at 800 343 9000 User support is available Monday through Friday between 7 00 AM and 10 00 PM and 8 30 AM to 5 30 PM on Saturday Sunday and holidays You may contact CSC s Provider Services Department at 800 343 9000 While the intent has been to provide sufficient concurrent telephone connections it is possible that you may encounter a busy signal Please try again at a later time December 2003 7 0 1 Availability of the eMedNY NCPDP BATCH PHARMACY 8 0 ECSS FILE FORMATS SUPPORTED Rev 12 03 The eMedNY EG currently supports the HIPAA compliant NCPDP Batch file format Please refer to the eMedNY website at http www emedny org HIPAA index html for the NCPDP guide to obtain the correct file and record format The electronic specifications contain the requirements and procedures that must be followed when submitting electronic media Access the NCPDP Companion Guides under the News and Resources tab on https www nyhipaadesk
23. ng certification training and experience to perform the claimed services have reviewed these claims or the entity have furnished or caused to be furnished the care services and supplies itemized and done so in accordance with applicable federal and state laws and regulations have read the Medicaid Management Information Systems Provider Manual and all revisions thereto all claims are made in full compliance with the pertinent provisions of the Manual and revisions all claims for care services and supplies provided at the order of another professional have to the best of my knowledge been ordered by that professional in bona fide compliance with the procedures set forth in the manual and revisions All care services and supplies for which claim is made are medically necessary for the treatment of the named recipient the amounts listed are due and except as noted no part thereof has been paid by or to the best of my knowledge is payable from any other source other than the Medical Assistance Program payment of fees made in accordance with established schedules is accepted as payment in full other than a claim rejected or denied or one for adjustment no previous claim for the care services and supplies itemized has been submitted or paid ALL STATEMENTS DATA AND INFORMATION TRANSMITTED ARE TRUE ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE NO MATERIAL FACT HAS BEEN OMITTED UNDERSTAND THAT PAYMENT AND SATISFACTION OF THIS CLAIM WILL
24. nt the following information a Provider Number only for enrolled providers or vendors with an assigned Medicaid ID number otherwise leave this field blank Enter your eight digit Medicaid Provider ID Number which was assigned by the Department of Health at the time of your enrollment in the Medicaid program b Provider Vendor Name Enter the name of the Provider Vendor that will be subject to the agreement If you have a Medicaid Provider ID enter the name associated with the Provider ID Number entered above C Street Address City State Zip Enter the address where you would like to receive correspondence from CSC Please note that it must be a Street Address not a P O Box d By Print the name of the authorized person who signs the Agreement e Title Print the title of the authorized person who signs the Agreement f Date Enter the date on which the Agreement is signed December 2003 17 0 9 Forms NCPDP BATCH PHARMACY SECURITY AGREEMENT NEW YORK STATE eMedNY SYSTEM All users of Medicaid data and systems are required to affirm their understanding and agreement to comply with the following USERID and Password rules before access can be granted USERID AND PASSWORD RULES A USERID and password will be provided by CSC eMedNY Data Security upon approval of this security agreement CSC in accordance with the Federal Information Processing Standards and the Privacy Act of 1974 requires that all users of the system
25. nual the revised user manual will be available for retrieval Refer to Section 13 0 for the Informational Documentation Retrieval procedure by accessing the eMedNY at CSC This manual will be available on the eMedNY org website at http www emedny org manuals index html Connecting to the EG may be accomplished by utilizing your personal computer configured with a modem and communication software December 2003 4 0 1 Manual Revisions NCPDP BATCH PHARMACY 5 0 HARDWARE AND SOFTWARE REQUIREMENTS Rev 12 03 Listed below are the minimum hardware and software requirements necessary to utilize the eMedNY Hardware e Personal Computer with Windows 98 ME 2000 or XP Operating System e MODEM capable of 1200 through 33600 BPS e Available Telephone Line Software Telecommunications software package capable of e Connection Rate 1200 33600 BPS e Parity None e Data Bits 8 e Stop Bits 1 e Protocol Send to CSC Receive from CSC Xmodem Text Kermit Ymodem Kermit Zmodem Kermit Kermit BINARY Kermit e Flow Control RTS CTS e Terminal Emulation Hyperterminal provided with Microsoft Windows 95 or greater ANSI VT100 and VT220 The Text Binary option may not be available with all protocols December 2003 5 0 1 Hardware and Software Requirements NCPDP BATCH PHARMACY 6 0 CERTIFICATION STATEMENT 6 1 ETIN Application for new submitters New electronic implementations Providers or Service Bureaus who choose to su
26. onic transactions for Medical Providers Vendors and their agents Provider Vendor to the eMedNY System and WHEREAS Provider Vendor performs certain medical services and or provides medical supplies for recipients who are eligible for MEDICAID benefits or performs data processing services for such entities and WHEREAS Provider Vendor has requested direct electronic access to the eMedNY System NOW THEREFORE CSC and Provider Vendor agree as follows 1 CSC eMedNY will supply to Provider Vendor the technical specifications required to establish the link to the eMedNY System Exhibit A Provider Vendor is responsible for all costs associated with complying with such requirements 2 Provider Vendor agrees to comply with the system requirements and any additional terms set forth on Exhibit A 3 After Provider Vendor has obtained initial access to the eMedNY System Provider Vendor agrees to re test its link to the System in the event e Provider s Vendors link is changed or modified in any way or e The technical specifications change in response to Department mandated program changes Provider Vendor agrees to follow CSC s then current procedures for obtaining such access 4 Provider Vendor agrees to pay any damages that are caused by result from or are in any way attributable to Provider Vendor its employees agents and independent contractors negligent use of the eMedNY System fraud or intentional misconduct or Provider s Vendo
27. pted to login At this time you must specify your appropriate access key information user identifier and password to gain access to the EG The prompts for user identifier and password will resemble the following SunOS 5 8 login your user identifier here ENTER Password your password here ENTER Upon successfully entering your access key information you will be greeted with the EG banner shown below After a few seconds the eMedNY system message s will be displayed Please review the system message s before proceeding You must depress the ENTER key to proceed beyond the system message screen s ELECTRONIC GATEWAY December 2003 10 0 1 Connecting to the eMedNY NCPDP BATCH PHARMACY 11 0 ELECTRONIC FILE SUBMISSION UPLOAD Rev 12 03 Upon depressing the ENTER key while on the eMedNY system message screen s you will be presented with the following MAIN MENU NEW YORK STATE MEDICAID MANAGEMENT INFORMATION SYSTEM ELECTRONIC GATEWAY eMedNY Tuesday July 29 2003 at 08 44 24AM MAIN MENU 1 TRANSMIT UPLOAD FILE S 2 RETRIEVE DOWNLOAD FILE S 3 INFORMATIONAL DOCUMENTS 4 ENVIRONMENT CONFIGURATION X EXIT GATEWAY ENTER OPTION DESIRED The MAIN MENU provides the ability to electronically submit a file upload electronically retrieve a response or informational document file download customize your environment and or exit the EG If option 1 2 3 or 4 is chosen you will b
28. rs failure to certify or re certify its link to the eMedNY System 5 Provider Vendor agrees to exercise due diligence in protecting Provider Vendor systems so that malicious software is not introduced to eMedNY Systems 6 Provider Vendor accepts and agrees to comply with the Provisions of the attached eMedNY Security Agreement 7 This Agreement shall become effective upon approval by CSC eMedNY on behalf of the New York State Department of Health and shall continue thereafter until terminated by either party on 60 days notice in writing i Provider Number Please print name os Se Provider Vendor Name Signature Title Street Address Date City State Zip December 2003 17 0 5 Forms NCPDP BATCH PHARMACY AGREEMENT for eMedNY System ACCESS EXHIBIT A SYSTEM REQUIREMENTS 1 Interactive Host to Host CPU CPU SNA Protocol LU6 2 o Compliance with Data Stream Formats Batch Host to Host o SNA Protocol o Compliance with File Formats Interactive PC to Host o Third Party Software e VISA 2 Protocol e Compliance with Data Stream Formats o Medicaid Eligibility e 233 MHz Pentium e 32MB RAM e 20 MB HDD e 14400 BAUD Modem e Windows 95 e Analog Telephone Line Batch PC to Host Dial up FTP o Point to Point Protocol PPP o TCP IP Protocol with File Transfer Protocol FTP o Compliance with File Formats OTHER TERMS 1 Provider Vendor shall order the telecommunication lines and equipm
29. ry LEAVE SECTIONS 4 AND 5 BLANK THESE ARE FOR CSC USE ONLY December 2003 17 0 7 Forms NCPDP BATCH PHARMACY PROVIDER VENDOR eMedNY Access Request Form 1 User Information m Position Title Phone Number Address INDICATE Medical Provider MEDICAID PROVIDER ID Service Bureau Connectivity Switch Provider Vendor Other ZzZOo d znaomz Domac 2 Alternate Access Required Please see exhibit A for minimum requirements FTP batch submission Dial up Zvonar Business Reason description of access required 3 Requestor Information Requestor s Name Date Phone Number 4 Approvals For CSC eMedNY Use Only Approver s Name Signature i Phone number Approver s Name Signature Phone number 5 Administration For CSC eMedNY Data Security Use Only Type of User ID assigned Comments Administrator Name Administrator Signature Date lt C Gmm YFHAYO New USERID Initial password December 2003 17 0 8 Forms NCPDP BATCH PHARMACY SECURITY AGREEMENT FOR NEW YORK STATE eMedNY SYSTEM Instructions for Completion 1 Please read the USERID AND PASSWORD RULES By signing the Agreement you indicate acceptance to the terms and conditions of this Agreement 2 Complete the information requested at the bottom of the Agreement form and sign the Agreement Please type or pri
30. tered into the next processing cycle for adjudication If the file transfer is successful and the file format is in error the following message will be displayed FILE TRANSFER REJECTED INVALID RECORD FILE FORMAT When the file transfer is rejected the file will NOT be passed on to any subsequent editing routines and will not be entered into any processing cycle Therefore a response file will NOT be generated The erroneous file format must be corrected and resubmitted to CSC for processing December 2003 11 0 3 Electronic File Submission Upload NCPDP BATCH PHARMACY 12 0 ELECTRONIC FILE RETRIEVAL DOWNLOAD Rev 12 03 Selecting the RETRIEVE DOWNLOAD FILE S option from the MAIN MENU will yield a screen similar to the following screen and additional related messages NEW YORK STATE MEDICAID MANAGEMENT INFORMATION SYSTEM ELECTRONIC GATEWAY eMedNY Tuesday July 29 2003 at 08 55 38AM eMedNY RETRIEVE MENU XXXXX BYTES IN 1 FILE TRANSFER AND OR RESPONSE FILE S C COMPRESS ALL FILES A RETRIEVE ALL FILES X EXIT RETRIEVE MENU ENTER OPTION DESIRED Where XXXXX is the total number of bytes or characters in YY files Depicting the total number of bytes will help facilitate calculating or projecting the required download time associated with your hardware and software configuration When the ALL option is chosen the eMedNY will begin the process of transmitting all of the files that are available for retrieval
31. the data is submitted electronically the data entry of claim forms or the manual processing associated with magnetic media is no longer required subsequently reducing the time required to prepare the data for entry into a processing cycle 2 Accelerated return of submission information Information with regard to the general acceptance of the data submitted will be available through the eMedNY for retrieval downloading within a short time frame 2 1 Information Repository Sources for eMedNY information can be found at the following e http www eMedNY org e http www health state ny us December 2003 2 0 1 Introduction NCPDP BATCH PHARMACY 3 0 eMedNY USER MANUAL NOTATION You will find typographical conventions used throughout this eMedNY User Manual Below is a table of those conventions that may be utilized Typographical Used for Convention A Anything that you must type exactly as it appears including case sensitivity Single Quotes sa related to information that is specific to you such as your user identifier Item password Less Than Greater Than Used to depict a specific key or combination of keys to depress ENTER Bracketed Item Bracketed items depict actual screens or messages that you will encounter when accessing the NYS MMIS EG September 2003 3 0 1 eMedNY User Manual Notation NCPDP BATCH PHARMACY 4 0 MANUAL REVISIONS Rev 12 03 As enhancements are made to this User Ma
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