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 authorization (see attached form PDF, 89k, pg. 1) to:

New York State Department of Health
Office of Health Insurance Programs
Division of Systems - Bureau of Data Warehouse
Data Access Unit
800 N. Pearl Street
3rd Floor - Room 322
Albany, New York 12204

NYS DOH OMM Authorization Form For Release Of Medicaid Protected Information To A Third Party Other Than A Medicaid Enrollee/Patient (PDF, 89KB, pg 1)

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 Identification Number (CIN) 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 Health Insurance Programs 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.
  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 Health Insurance Programs if the document has any of the following;

  • The expiration date on the authorization has passed
  • 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.

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.