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.

Attention providers: United Healthcare will no longer accept paper claim reconsiderations or post-service appeal submissions starting February 1 2023. These will need to be submitted electronically. Your electronic submission options 1. UnitedHealthcare Provider Portal: Submit under Claims & Payments. Need help? See the Online Reconsiderations and Appeals interactive guide for a step-by-step guide on how to submit reconsiderations and appeals electronically. 2. Application Programming Interface (API): Consider submitting reconsiderations and appeals through API. Data can be distributed to your practice management system or any application you prefer. API requires technical programming between your organization and UnitedHealthcare, so advanced planning is required. See the full article, please follow the link.

PCG has found that there has been increase of rejections from Medicaid for A7:521-Invalid Claim Adjustment Reason Code (CARC). It has been determined that this is occurring due to incorrectly entered commercial EOBs that are either missing a group code or have an incorrect CARC posted. Medicaid will not be able to correctly process claims if there is not a complete and valid denial posted. Please follow the link for additional details and guidance.

As of May 8, 2023, EI Billing will transfer to a new hosting location, Amazon Web Services (AWS). EI Billing will have a planned system downtime scheduled on 5/5 – 5/8 to prepare for this transition. Please follow the link for more details.

In accordance with Federal Law, Providers who received payments for Early Intervention Services in the 2022 calendar year should expect to receive a number of 1099 forms. Providers will receive a 1099 from New York State Department of Health via the State Fiscal Agent (SFA) for amounts from the State Escrow account in 2022, a 1099 from Medicaid, and a 1099 from each insurance company. Please follow the link for details.

Please click here to download the 2023 Escrow Payment Calendar

The updated list of the ICD-10 codes that were made available in NYEIS as of January 18, 2023, is accessible via the above link. If providers determine that there is an ICD-10 code needed in NYEIS for billing purposes, a feature request form must be submitted and include both the code and description. The form is available on the Health Commerce System (HCS) in the “Feature Request – Data Change Request” folder within the NYEIS Documents group. Requests will be reviewed prior to being entered into NYEIS. Please allow up to 6 - 8 weeks from the date the Feature Request Form is received for the code to be available in NYEIS. If you need further information regarding NYEIS in general, please contact the NYEIS help desk at nyeis@cma.com or by calling (toll free) 1-(833)-395-7058, or 518-640-8390

The Bureau of Early Intervention (BEI) is implementing an ATB 1% rate increase on payments for Early Intervention (EI) services, including Service Coordination, Evaluations and General Services. The 1% rate increase will be reflected in both Medicaid and Escrow payments. The rate increase will be retroactive and apply to services rendered on or after 4/1/2022. For more information, please follow the link.