The article outlines the importance of maintaining Medicaid enrollment through recertification and revalidation. The article also outlines the necessary steps to maintain each type of enrollment. Follow the link for more information.

A helpful grid outlining when a corrected claim, void, resubmittal/adjustment are done is now available for reference. Please follow the link for additional details.

PCG has found that there has been an increase in incorrect use of Medicaid delay reason codes. It is the responsibility of the providers to utilize the appropriate delay reason codes. Delay reason codes are used on claims billed beyond Medicaid’s 90-day initial filing limit or when resubmitting claims with updated information within the 60-day resubmission window of claims denied or rejected. Please follow the link for additional details and guidance.

If your Medicaid claims were denied due to the expiration of the filing time limit (code 29), and you used delay reason code 15 (related to a natural disaster or state of emergency), the Department of Health (DOH) can review them manually. To learn more about why code 15 was valid for your claims, please contact the Bureau of Medical Review's Pended Claims Unit at 1-800-342-3005 (select option 3).

PCG has found that there has been an increase in ongoing rejections from Medicaid due to providers utilizing invalid or expired ICD-10 codes. Please follow the link for additional details and guidance.

As of today, October 7, all NYEIS processing of data entered and claim files submitted as of Friday, October 4 at 5:00 PM has been completed. NYEIS is now in a read-only format. Please follow the link for more information.

The NYEIS system will be taken offline today at 5:00pm to facilitate the transition to the EI-Hub. The EI-Hub is scheduled to launch on October 15, 2024. A listserv notification will be sent once the system is available to end-users. Please follow the link for more information.

The current claiming method used by Billing Providers in NYEIS will be carried over to the EI-Hub. Billing Providers can switch claiming methods after the EI-Hub launch on October 15, 2024, by contacting the Call Center at 866-315-3747. When contacting the Call Center, you will be asked to provide your name/agency, NPI, TIN, and name of your third-party vendor, if applicable.

If your agency currently submits claims manually via NYEIS and will be using Service Logging to submit claims in the EI-Hub, it is crucial to understand the following to ensure uninterrupted billing once the EI-Hub is formally launched on October 15, 2024. All rendering providers must have a Health Commerce System (HCS) account and an EI-Hub Case Management user role to become active and available for selection on Service Authorizations in the Service Logging module. This account setup is required for entities to enter claims and bill for services delivered by their rendering providers. Please follow the link for more details.

Following the launch of the EI-Hub, providers should include a telehealth modifier on all relevant claims. This modifier will help quantify the number of children receiving telehealth services. This article outlines how providers should add the modifier, depending on the billing and claiming method used. Please follow the link for more details.