Office of the New York State Comptroller (OSC)

Department of Health – Medicaid Program: Oversight of Electronic Transmitter Identification Numbers (2024-S-34)

An electronic transmitter identification number (ETIN) is a unique identifier used to submit fee-for-service claims to Medicaid.  Per Medicaid policy, all entities that submit claims to Medicaid must have an active, certified ETIN affiliation on file before submitting claims.  Auditors found that DOH has not implemented adequate controls to ensure that ETIN affiliations meet requirements.  As a result, the Department of Health’s Medicaid claim processing and payment system processed nearly 10.8 million claims submitted with 783 ETINs that were not affiliated with the billing providers on the date of service.  The control deficiencies identified reduce visibility into the claim submission process, creating uncertainty about whether claim submitters who may have been previously authorized are still authorized to submit claims.