NYS Medicaid Codes - What do they Mean?

When you prepare for a fair hearing and obtain an evidence packet, and in some other instances, you obtain screenshots from the eMedNY system - the computer system that stores Medicaid eligibility information,  which providers use to look up eligibility of their  patients.  Local Medicaid offices or the NYSofHealth enter these codes into the system.

Here are a few references that might shed light on what some of these codes mean:

•  NYS DOH-OTDA WMS Workers' Guide to Codes (6-17-2018)  

  • Chapter 4 is Medicaid - Use "bookmarks" in  PDF

• eMedNY MCE 834 Companion Guide (version 3.4)   (8/1/2024)- guide published for Medicaid  providers but that can be useful for consumers  and advocates to understand the mysteries of eligibility codes.  

  • This is one of  many guides posted on a webpage called eMedNY 5010/D.0 Transaction Instructions which is in turn posted on the eMedNY.org support webpage.

• Guide to Restriction Exception (RE) Codes and Health Home Services (7/2/2024)

Down the road we hope to post more helpful guides to understanding the most common eligibility codes.