Doula Provider Enrollment and Billing Information

Table of Contents

• New York State Medicaid Fee-for-Service Enrollment
• Preparing for Individual Enrollment
• Individual Enrollment Training Videos
• New York State Medicaid Fee-for-Service Doula Directory
• Medicaid Managed Care
• Preparing for Fee-For-Service Billing
• Fee-for-Service Billing Training Videos
• Standing Order for Doula Services

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New York State Medicaid Fee-for-Service Enrollment

• Doula services are a permanent Medicaid benefit. Doulas are able to enroll on an ongoing basis. There is no deadline to apply.
• Doulas must be enrolled in Medicaid as Fee-for-Service providers in order to contract with Medicaid Managed Care plans.
• Doulas must be enrolled as individual Medicaid providers in order to affiliate to a doula-only group or multi-professional group.
• New York State Medicaid fee-for-service provider enrollment is transitioning to an online portal, known as the Provider Services Portal. This transition will impact all current and future Medicaid providers.

Visit eMedNY to enroll in Medicaid as Fee-for-Service providers:

All individual doula services providers, doula-only groups, and multi-professional groups enrolling for the first time should now utilize the Provider Services Portal, available here: eMedNY Provider Enrollment & Maintenance (External Link).

All questions regarding the Provider Services Portal and portal enrollment can be directed to the eMedNY Call Center at 1-800-343-9000 or providerenrollment@health.ny.gov.

Individual Enrollment

• Doula-specific enrollment forms are to be uploaded to the portal. These forms can be found here:
  • Doula Attestation Form - form #433402 (External Link): Required for all Doula applicants: Work Experience Pathway and Training Pathway applicants
  • Doula Client and Professional Recommendation Forms - form #433403 (External Link): for Work Experience Pathway only
    • Form available in 16 additional languages (External Link).
• Enrolling doulas must continue to complete and update their fee-for-service doula directory entry. The link is available here: New York State Medicaid Fee-For-Service Doula Directory.

Doula-only groups & Multi-professional Groups

• Visit the Provider Services Portal to enroll.

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Preparing for Individual Enrollment

• This information is in the process of being updated to reflect portal enrollment changes.
• All enrollment information is for Fee-for-Service. For Managed Care Contracting, please see the section Medicaid Managed Care.
  • Find all required forms and guidance documents: Doula Services Enrollment (External Link).
  • A list of all enrollment requirements and checklist of required forms: Doula Enrollment Instructions (External Link).
  • A review of the two different enrollment pathways: Training Pathway or Work Experience Pathway.

Schedule a Session with the Medicaid Team

• The New York State Medicaid team is available to meet with individual doula groups and organizations to provide information about the doula services benefit. To schedule a meeting, reach out to MaternalAndChild.HealthPolicy@health.ny.gov.
• All questions regarding the Provider Services Portal and portal enrollment can be directed to the eMedNY Call Center at 1-800-343-9000 or providerenrollment@health.ny.gov.

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Individual Enrollment Training Videos

Session	Length	Info	Slides	Link
Enrollment Informational Sessions	2 hours	Medicaid team walks through enrollment process and all required forms SPA Approval and Provider Manual Enrollment Information & eMedNY Application Timeline Resources Revalidation	PDF	YouTube
Enrollment Training Videos	Each video is 5-15 minutes	Doula Enrollment Support Navigating the eMedNY Website Doula Enrollment Instructions and Pathways EFT and ETIN Forms Practitioner Enrollment Form and Doula Sample Doula Directory Form Doula Attestation Form Doula Client and Professional Recommendation Form	PDF available for each video	emedny.org/training/videos.aspx Select "Doula" at the top of the page

*Videos on YouTube can be viewed with captions in other languages. First, click the "CC" button to turn on subtitles/closed captions. Next, click the "Settings" button and select "Subtitles/CC English (auto-translated)". Finally, click "Auto-translate" and select your language.

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New York State Medicaid Fee-for-Service Doula Directory

• Doulas will be added to the doula directory once their enrollment is approved.
• Doulas are responsible for ensuring the information in the doula directory is accurate. If doulas need to update their responses, please submit a new response.

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Medicaid Managed Care

• Doula services were carved out of the MMC plan benefit packages from March 1, 2024, through March 31, 2025.
• All Medicaid Members who are enrolled in FFS or MMC plans are eligible for Medicaid coverage of doula services during and after the MMC carve out.
• Doulas must first enroll with FFS in Medicaid before they can contract with MMC Plans.
• Each MMC Plan will have their own contracting process for doulas.
• More guidance about the Carve-Out can be found in the Provider Manual.
• To see which Medicaid Managed Care Plans operate in each New York State county, see the information below:
  • Medicaid Managed Care Enrollment Reports: view the report for the current year and month to see total enrollment in each MMC plan. Organized by county.
  • Managed Care Organization (MCO) Directory by Plan: view which programs are offered by each Managed Care Organization in each county. Organized by plan.
• The Medicaid Office has compiled a list of points of contact at each MMC plan for doulas. Please see the table in the dropdown tab below.

Point of Contact List

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Preparing for Fee-for-Service Billing

Doula Services Billing Information on eMedNY.org:

• Doula Provider Manual
• General Billing Guidance
• Doula Billing Guidelines
• For further billing support and questions, please contact the eMedNY call center at 1-800-343-9000 or submit a contact form.

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Fee-for-Service Billing Training Videos

Session	Length	Info	Link
Intro to Billing for Doulas (Part 1)	2 hours	Provider Manual Fee Schedule Billing Codes Eligibility Claim Submission Intro Timely Billing	YouTube
ePACES for Doula Webinar (Part 2)	2 hours	Review of claim completion; Professional Real Time Submission Explanation for Submitting Voids, Adjustments (Replacement), Claims over 90 Days Review of MEVS Transactions (Eligibility), Claim Status, Support Files, etc. Review of Secondary Billing Review of Online Resources - Provider Manual, MEVS Manual, DOH Doula Services website, etc.	YouTube
Register for upcoming live sessions	2 hours	Check monthly training calendar for upcoming doula-specific sessions	emedny.org/training/

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Standing Order for Doula Services

• The State Health Commissioner Dr. James McDonald issued a statewide standing order that all New Yorkers who are pregnant, birthing, or postpartum would benefit from receiving doula services. This order is another step in expanding access to doula care and fulfills the requirement for a provider recommendation for services to be covered by Medicaid. The standing order will allow doulas to provide physical, emotional, educational, and non-medical support for pregnant and postpartum individuals before, during, and after childbirth or at the end of pregnancy through 12 months postpartum.
• This order fulfills the federal requirements in section 440.130(c) of title 42 of the Code of Federal Regulations for a physician or other licensed practitioner of the healing arts acting within their scope of practice to provide a written order for preventive services.