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New York State FeeForService Medicaid Program Prior Approval for OutofState Medical Treatment Instructions (To be completed by the Referring Practitioner): A. Member Information: Include full name,
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New York State fee-for-service is a payment model in which providers are paid based on the number of services they provide.
Healthcare providers in New York State who provide services on a fee-for-service basis are required to file.
Providers can fill out the New York State fee-for-service form online or submit paper forms by mail.
The purpose of New York State fee-for-service is to ensure that healthcare providers are properly compensated for the services they provide.
Providers must report the services provided, dates of service, and charges for each service on the Fee-for-Service form.
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