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PB Home  Back to Documents : HELP with PPPL Requests    

Documents : HELP with PPPL Requests

PPPL Requests to DOH for Medical Assistance (Medicaid) Payment Records (Claim Detail Reports)

The DOH website devotes a separate page to obtaining Medicaid payment records under the PPPL: http://www.health.ny.gov/health_care/medicaid/medicaid_release.htm.

These records, referred to as claim detail reports, list every Medicaid payment made for a recipient's medical care, supplies and services for any given period of time since the 1980s. They include the names of providers, diagnostic codes, medical procedure codes, names and dosages of prescription drugs, and payment amounts.

This data is a useful tool for development of disability claims, for requesting medical records, particularly when hospitals want precise dates of emergency room or inpatient admissions, and for verifying medical conditions and treatment in an effort to establish "good cause" for failure to comply with Public Assistance or other eligibility requirements. These records are also invaluable for calculating the amount of Medicaid expenditures in personal injury cases.

DOH provides two separate PPPL authorizations for Medicaid recipients:

1. Release of Medicaid Payment Records to Third Parties: http://www.health.ny.gov/health_care/medicaid/docs/cdr_third_party.pdf, and

2. Release of Medicaid Payment Records to Medicaid Recipients: http://www.health.ny.gov/health_care/medicaid/docs/cdr_request_auth_for_member.pdf.



Created: 7/5/2008
Updated: 12/8/2015