Obtaining Payment Records

Medicaid regulations allow enrollees/patients to obtain copies of their Medicaid payment records directly or authorize to have them sent to a third party, usually legal counsel. In order to have your Medicaid payment records sent to a third party please refer to the section below entitled Requesting the Release of Information to a Third Party. In order to have your payment records sent directly to you please refer to the section below entitled Requesting Information be Released Directly to the Enrollee/Patient.

Requesting the Release of Information to a Third Party

The Health Insurance Portability and Accountability Act (HIPAA) requires the Medicaid program to have an authorization from individuals before releasing protected health information for any purpose. Therefore, Medicaid enrollees/patients requesting that their Medicaid payment records be released to another party must submit a letter from the third party along with an original notarized authorization (see attached form PDF, 89k) to:

Bruce Lombardo
Medicaid Specialist II
New York State Department of Health
Office of Medicaid Management
99 Washington Avenue
7th Floor Suite 720
Albany, New York 12210

NYS DOH OMM Authorization Form For Release Of Medicaid Protected Information To A Third Party Other Than A Medicaid Enrollee/Patient (PDF, 89k)

Copies of this document may also be obtained by contacting the New York State Department of Health Public Web Site Administration at dohweb@health.state.ny.us.

The letter requesting Medicaid payment records must include the enrollee's/patient's Medicaid Client (CIN) Identification Number and the dates of service they are requesting the report to cover, along with their name, date of birth and Social Security Number.

Authorizations for release must comply with the following:

  1. Authorizations should be addressed to the New York State Department of Health, Office of Medicaid Management at the above referenced address.
  2. Authorizations must state to whom the records are to be sent.
  3. Authorizations must be signed by the enrollee/patient and the enrollee's/patient's signature must be notarized.
  4. Authorizations must be originals. Photocopies are unacceptable.
  5. Authorizations must not contain any whiteout or substitutions/deletions.

An authorization is not valid and will not be honored by the Office of Medicaid Management if the document has any of the following;

  • The expiration date on the authorization has passed or the expiration event is known by the covered program to have occurred
  • The authorization has not been filled out completely
  • The authorization is known to have been revoked
  • Any material information in the authorization is known by the covered program to be false.
  • The authorization is not notarized

Judicial subpoenas of Medicaid confidential data should be directed to Joseph C. Bierman, Esq., Bureau of Litigation, Division of Legal Affairs, New York State Department of Health, Empire State Plaza, Corning Tower Building, Room 2438, Albany, New York, 12237.

Requesting Information be Released Directly to Enrollee/Patient

If you are a enrollee/patient, Federal regulations permit you to request Medicaid payment records be released directly to you. If you want to request this information please complete the following form and send it to the address on the bottom of the form.

Copies of this document may also be obtained by contacting the New York State Department of Health Public Web Site Administration at dohweb@health.state.ny.us.