Federal Government Delays ICD-10 Implementation Medicaid Required by Federal Law to Change Electronic Remittance Delivery Date Important Notice to Pharmacy Providers Regarding Prescriptions Written by Ordering/Prescribing/Referring/Attending (OPRA) Providers Ordering/Referring Enrollment and Claims Editing Implementation in Fee-For-Service (FFS) Medicaid October 25, 2013 - NY Medicaid Guidance for Enrolled Practitioners Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) or PDF Remittance Advice August 1, 2013 - New Requirements for All Billing Providers to Begin on August 22 May 20, 2013 - Primary Care Rate Increase Attestation Now Available
The ICD-10 code set implementation date has been moved from October 1, 2014 to no earlier than October 1, 2015. The delay was part of the Protecting Access to Medicare Act of 2014 recently passed by Congress and signed into law by President Obama on April 1, 2014. New York Medicaid will adhere to the new federal compliance timeframe for ICD-10 implementation and eMedNY will not accept ICD-10 codes until October 1, 2015 at the earliest.
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Effective April 7, 2014 (Cycle 1911) eMedNY will no longer be permitted to make the X12 835 and the X12 820 electronic remittances available two weeks prior to release of payment. Electronic remittances will be available two days prior to the release of funds. The change is necessitated by requirements of Section 1104 of the Affordable Care Act (ACA) and the CAQH Committee on Operating Rules for Information Exchange (CORE), the authoring entity for operating rules for Electronic Fund Transfer (EFT) and Electronic Remittance Advice (ERA) transactions. CORE Rule 370 requires that transmission of the 835 cannot occur more than three days prior to the availability of the EFT.
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Effective February 3, 2014 the Department will discontinue payment for all prescriptions for Medicaid fee-for-service members ordered by a provider not yet enrolled as an OPRA provider. If you have such a prescription you will receive a reject code of "56" via NCPDP transaction stating the provider has a non-matched Prescriber ID listed in NCPDP field number 511-FB.
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Effective January 1, 2014, FFS Medicaid will implement new FFS claims editing requiring Medicaid FFS enrollment for ordering/prescribing/referring/attending (OPRA) physicians and other healthcare professionals. If the ordering professional is not enrolled, under federal law Medicaid must deny the claim for the ordered service.
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As previously announced the NYS Department of Health now requires all billing providers to sign up for EFT and either ERA or PDF remittances. Existing enrolled providers have begun receiving notices with their yearly Certification Statement, indicating (based on their existing enrollment information) whether they need to complete and submit the EFT and/or ERA/PDF forms in addition to submitting the signed and notarized Certification Statement. The forms will be included with the Certification Statement and preprinted with the provider information.
IMPORTANT: Billing Providers are urged to read the following notice. Failure to follow the new requirements outlined below will result in claim rejection and jeopardize payments. As previously announced the NYS Department of Health will soon require all billing providers to sign up for EFT payments and either ERA or PDF remittances.
Existing Enrolled Providers
Beginning on August 22, 2013, and for the following 12 months, as your Electronic Transmitter Identification Number (ETIN) approaches its yearly expiration date, providers will be sent notifications instructing them to complete either or both of the application forms (EFT and ERA or PDF). If you are already signed up for both EFT and ERA or PDF remittances, you need only return the signed/notarized certification form ... more
Attention: Primary Care Rate Increase Attestation Now Available
Under the Affordable Care Act, Medicaid managed care and fee for service primary care practitioners may qualify for increased reimbursement at the rate that would be paid for primary care services under Medicare. To determine if you qualify for the program, review the FAQ document. If you qualify, complete and return the attestation form by August 1, 2013 to be eligible for the increased reimbursement effective for dates of service on and after January 1. 2013. Payments will begin upon federal approval.
For specific questions, please review the FAQ document. Additional questions can be forwarded to: firstname.lastname@example.org.
Providers can sign up to receive ongoing updates on the PCRI program at: PCRI-L@listserv.health.state.ny.us and through the eMedNY listerv at https://www.emedny.org/Listserv/eMedNY_Email_Alert_System.aspx.