General Information
General InformationAll PA types have several common sections on the General Information tab including Client Information, Requesting Provider Contact, Requested Service, Diagnosis, Attachments, and Comments sections. Following the Requesting Provider Contact sections is a section that is used to identify hospital, referring, ordering, or prescribing providers relevant to the PA.
The first page displayed after selecting the PA type contains only the Enter a Client ID field of the General Information tab. Enter the desired Client ID and click Go. This will return the entire General Information tab including the expanded Client Information section which contains client demographic data including Name, Gender, Date of Birth, and Fiscal County. The Client Information section allows you to change the Client ID if you discover that you previously entered the wrong value.
The Requesting Provider sections (Requesting Provider Contact and Requesting Provider) display demographic information about the requesting provider. The section's other fields contain data populated from the eMedNY database. You may change these data if required.
The Requesting Provider Contact section displays data initially populated from the eMedNY database, but it may be changed if not correct for this particular PA. The changes will only apply to the PA and will not change the data stored in the eMedNY database.
Provider Name: The provider's name. Names available to you are those for which you have authority to submit transactions.
Contact Name: An optional name, normally identifying clerical or technical staff.
Address Line 1 and 2: The street and, optionally, building name in the provider's address. You may override the address line fields as well as the City and State fields if another location is required for this particular PA.
City: The city or town name in the provider's address.
State: The state name in the provider's address.
Telephone: The contact's telephone number.
The Requesting Provider section captures the Taxonomy Code.
Depending on the PA type, the section following the Requesting Provider area is one of the following: Hospital, Referring Provider, Ordering Provider, Prescribing Physician or Prescribing Provider section. These sections are used to identify which one of the providers are relevant to the PA. These sections use a common Provider Search mechanism.
Hospital: This section allows you to identify the hospital to which your patient will be admitted.
Referring Provider: This section allows you to identify the provider that has referred the patient for the service.
Ordering Provider: This section allows you to identify the provider that has ordered the service for the patient.
Prescribing Physician: This section allows you to identify the provider that has prescribed the service for the patient.
Prescribing Provider: This section allows you to identify the provider that has prescribed supplies or devices for the patient.
The Diagnosis component provides a mechanism for entering the Primary and Secondary diagnosis codes. Only ICD-9-CM diagnosis codes are acceptable.
The Attachments section provides a mechanism for identifying attachments associated with this request. Since attachments cannot currently be physically included with the request, they are transmitted separately from the request. The section is an arrangement of attachment fields followed by an Enter More Attachments link that allows for entry of 5 additional attachment fields.
Each attachment is identified and described by the following fields:
Type: This field may be populated from the associated pop-up and identifies the type of attachment.
Transmission Code: This field may be populated from the associated pop-up and identifies the method by which the attachment will be transmitted to eMedNY.
Control Number: This field identifies the attachment's control number in your records. It is an internal number that is for the provider's office use only and does not correspond to the subsequent PA number issued by NYS Medicaid.
Description: This field describes the attachment.
The Comments component allows you to enter free form text that clarifies the request.