N.Y. Comp. Codes R. & Regs. tit. 18 § 540.4

Current through Register Vol. 46, No. 45, November 2, 2024

Section 540.4 - Notification to public welfare official for medical services

(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.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 540.4