SA Confirm Request

The following data may be entered when requesting an Service Authorization Confirmation.

Enter the desired Client ID and click Go, this will return the associated Client information below the prompt. The client's full name, gender, and birth date will be displayed as confirmation that the correct ID was entered. If this is not the desired client, re-enter the ID and search again.

Card Sequence Number: The 2-digit sequence number of the Client's Medicaid card must be entered for all requests.

Requesting Provider

Taxonomy Code: Enter the Taxonomy code of the provider requesting the Service Authorization. The Requesting Provider is that which is currently logged into the ePACES system; validate the name displayed in the upper left hand corner of the page is the proper Provider. See the appropriate Taxonomy Code/Service Type combinations for NYS Providers and Out-of-State Providers.

Requested Service

Type of Service: Enter or select the code for the type of service rendered, for which service is to be authorized. See the appropriate Taxonomy Code/Service Type combinations for NYS Providers and Out-of-State Providers.

Service Date: The date for which Authorization is being requested. The date may not be greater than the current date. The format for the date is: MM/DD/YYYY and may either be entered in the field or selected from the calendar available by pressing the button to the right of the field. The field will default to the current date.

Either Units information or Rx/Lab quantities may be entered. For each type, up to 999 units may be entered.

Service Units Delivered: The number of Service Units provided by the Requesting Provider. For Hospital/Clinic Providers only - if the primary service is x-ray and the Type of Service entered is "4 - Diagnostic X-Ray" or "62 - MRI/CAT Scan", enter the number of Radiological Services performed. This is used to calculate the co-payment.

Once all necessary information has been entered, clicking Submit will transmit the request and clear the data entered so that you may submit another confirmation request. To see the details of a response to your request, click the SA Confirm Responses link in the left-hand menu to open the SA Confirm Activity Worklist.

SA Confirmation Request

Requesting Provider

Requested Service

Either Units information or Rx/Lab quantities may be entered. For each type, up to 999 units may be entered.