New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter E - Medical Care
Article 3 - Policies and Standards Governing Provision of Medical and Dental Care
Part 514 - Provider Verification Of Recipient Eligibility And Orders For Service
Section 514.4 - Medicaid eligibility terminal (MET)
Current through Register Vol. 46, No. 39, September 25, 2024
(a) The MET is an electronic device which permits a provider to verify MA recipient eligibility immediately through EMEVS. Any provider who establishes a need to the department's satisfaction may request the department to provide a MET.
(b) The department may require a provider to verify MA recipient eligibility by using a MET if the department determines that the provider's claims or orders for MA care, services or supplies meet or exceed one or more of the criteria set forth below:
(c) If a provider is required to use a MET by the department, the provider must continue the use of the MET until such time as the department informs the provider in writing that MET use by the provider is no longer mandatory. Not less than one year after a provider has been required to use a MET, the provider may request that the department rescind its order for mandatory MET use by such provider on the ground that the provider's billings during the yearly period preceding such request do not fall within any of the criteria set forth in subdivision (b) of this section.
(d) METS will be provided by the department without charge to providers who establish a need and to providers who are required to use them. METS supplied by the department remain the property of the department.
(e) If the department requires a provider to use a MET, the provider must use the MET verification procedure unless the MET or EMEVS is not functioning. Any MET or EMEVS problems should be reported immediately through the emergency telephone numbers set forth in the EMEVS provider manual.
(f) When the provider who has been required to use a MET is unable to use the METbecause the MET or EMEVS is not functioning, the provider must verify eligibility by accessing EMEVS by telephone.
(g) If a provider who is required to use a MET does not use the MET verification procedure or the alternative telephone verification procedure, payments for any claims submitted where eligibility was not verified will be denied. If the department finds a significant number of unjustified failures by the provider to use the MET, the department may treat such provider failures as an unacceptable practice under Part 515 of this Title.
