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 540.7 - Requirements for billing

(1) patient name, case number and date of service;

(2) itemization of the volume and specific types of care, services and supplies provided (including for a physician, his final diagnosis, and for drugs, the prescription filled);

(3) the unit price and total cost of the care, services and supplies provided;

(4) vendor name and address;

(5) the social security number or employer identification number of the vendor in accordance with the following:

(6) for the initial billing only, the following documentation for persons admitted on or after May 14, 1976 to skilled nursing facilities holding title XVIII provider agreements shall be required. Claims for medical assistance payments shall not be processed if any element of the required documentation as herein provided is not submitted by the skilled nursing home operator:

(7) in the case of hospital bills submitted to the local department of social services for inpatient, general hospital care, services and supplies, the hospital shall maintain on file the notification of coverability made by the Commissioner of Health or his authorized representative attesting to the appropriateness and necessity of such care, services and supplies in accordance with Part 505 of this Subchapter. No billing for payment shall be made for care, services or supplies for any period of time for which coverability has not been determined by the Commissioner of Health or his designee;

(8) a dated certification by the provider that the care, services and supplies itemized have in fact been furnished; that the amounts listed are due and owing and that, except as noted, no part thereof has been paid; that payment of fees and rates made in accordance with established schedules is accepted as payment in full for the care, services and supplies provided; that there has been compliance with title VI of the Federal Civil Rights Act of 1964 in furnishing care, services and supplies without discrimination on the basis of race, color or national origin; that such records as are necessary to disclose fully the extent of care, services and supplies provided to individuals under the New York State Medicaid program will be kept for a period of not less than six years from the date of payment unless otherwise required by regulation, and information will be furnished regarding any payment claimed therefor as the local social services agency or the State Department of Social Services may request; and that the provider understands that payment and satisfaction of this claim will be from Federal, State and local public funds and that he or she may be prosecuted under applicable Federal and State laws for any false claims, statements or documents, or concealment of a material fact provided, however, that each bill need not contain the dated certification required by this paragraph in cases where the care, services or supplies (other than the services of a clinical laboratory) were furnished in a Canadian province or in a state other than the State of New York by a provider with a principal place of business outside the State of New York so long as the provider has previously filed with the department a certification containing all of the provisions required by this paragraph which will be applicable to all bills to be submitted by the provider during the period of the provider's participation in the medical assistance program.

(9)

(10) In the case of bills for physician services, physicians are required to maintain complete, legible records in English for each patient treated. Medical records shall include at a minimum, but not be limited to, the following: