The Division of Operations and Systems, Bureau of Medical Review, has been preparing for the change from ICD-9 to ICD-10 diagnosis coding in all prior approval units. Please note the following changes related to the prior approval/authorization processes
Currently, certain Behavioral Health (BH) benefits are paid Fee for Service (FFS) for managed care enrollees if they meet the condition of Medicaid categorization as SSI or SSI related or for individuals who require services that were previously carved out of Medicaid managed care (MMC). Effective October 1, 2015 Behavioral Health services will be transitioned into the benefit package for Mainstream managed care plans for adults (21 years of age and older) in New York City, requiring these (BH) provider claims be billed to the managed care plan. Commencing July 1, 2016 adults in the Rest of State will transition.
The Department of Health and Xerox State Healthcare, LLC are working diligently on the design and development of the new Medicaid system, called NYMMIS.
NYMMIS has an interim website created as an "information billboard." It will be used as a main source for communicating information, providing updates and email bulletins regarding the implementation of the new system. In addition updates will be provided on a regular basis in an effort to share relevant NYMMIS information and its potential impact on providers' business processes. Our interim website is also hosting a ListServ signup section. Once you sign up we will be able to email you with timely and updated news on the project and how it will affect you.
This notice is to advise impacted providers that effective May 8, 2015, the 2 percent Across-the-Board Medicaid payment reduction will be eliminated for claims with service dates on or after April 1, 2015. This change will be reflected in checks issued in Cycle 1969 (checks dated May 18, 2015 with a release date of June 3, 2015). The retroactive repayment of the reduction taken over the period April 1, 2014 through March 31, 2015 is still pending federal Centers for Medicare & Medicaid Services (CMS) approval.
On July 28, 2014 eMedNY opened the Provider Testing Environment (PTE) for submitters to begin testing Medicaid claims with ICD-10 diagnosis codes. In addition inpatient hospital claims that utilize ICD-10 procedure codes may be tested beginning on this date.
Date of Service Requirement
When submitting test claims with ICD-10 codes submitters must use a date of service of July 1, 2014 or any date of service up to the date of the test submission. Future dates are not allowed. Submitters who may be testing claims with ICD-9 codes must use a date of service prior to July 1, 2014.
ATTENTION: MEDICAID NOW REQUIRES ALL BILLING PROVIDERS TO REGISTER FOR ELECTRONIC FUNDS TRANSFER (EFT) PAYMENTS AND EITHER ELECTRONIC REMITTANCE ADVICE (ERA) OR PDF REMITTANCES.
Billing providers who have not registered for EFT and ERA or PDF remittances will not be allowed to re-certify their Electronic Transmitter ID Number (ETIN). When the ETIN expires a provider's claims will be rejected by eMedNY. It is therefore very important that providers who have not registered for EFT and ERA or PDF remittances do so right away. Waiting for your ETIN to approach expiration will jeopardize your payments.
This website is provided as a service for providers and the general public, as part of the offerings of the electronic Medicaid system of New York State. You'll be able to find helpful manuals and reference material, and get answers to questions about New York Medicaid. The site is updated regularly to meet the ever-growing needs of the New York State provider community. If you need help finding what you're looking for, please visit our Site Map, use the search above, or you can contact us directly for assistance.