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 5 - Procedures and Forms
Part 540 - Authorization Of Medical Care
Section 540.4 - Notification to public welfare official for medical services
Universal Citation: 18 NY Comp Codes Rules and Regs ยง 540.4
Current through Register Vol. 46, No. 12, March 20, 2024
(a) General.
(1) Notification by a physician, dentist,
hospital or other vendor of a request for authorization to furnish items of
medical assistance shall be furnished to the appropriate public welfare
official for the purpose of receiving advance authorization to render service,
where such advance authorization is required by rules of the board or
regulations of the department, except by a hospital in case of emergency as
defined in section
540.2
of this Part, in which case notification shall be given within the time
specified in that section.
(2)
Notification shall consist at least of:
(i)
case and patient (if other than name of household head), identification date
and place of services to be rendered, and/or already rendered if
emergent;
(ii) preliminary
diagnosis;
(iii) estimated scope of
services to be rendered (number of visits, and/or special auxiliary services
required);
(iv) name and address of
physician, dentist, hospital or other vendor providing services;
(v) identification of vendors of special
auxiliary services requested if known.
(3) Such notification may be furnished in
writing by the professional attendant or vendor or may be made verbally, in
which event the public agency shall reduce the contents of the notification to
writing at once. For either such purpose, the agency shall utilize a form
providing the minimum content of section A of the illustrative form M-1
contained in the instructions of the department.
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