Attention NYS Medicaid Providers: Guidance for the Use of 90 Day Date of Service Billing Rule Delay Reason 15 (Natural Disaster/State of Emergency)

Generally speaking, providers in New York State Medicaid program have to submit their claims for reimbursement within 90 days after the date of service unless special circumstances apply. One of the Delay Reason Codes that may be used when billing for reimbursement beyond the 90 day window is Delay Reason 15 Natural Disaster/State of Emergency.

The New York State Medicaid program has determined that, “during the State of Emergency or until the issuance of subsequent guidance by the NYSDOH prior to the expiration of such state disaster emergency declaration, claims that would normally have been required to be submitted during the State of Emergency exceeding the timely filing limits may be submitted electronically using Delay Reason 15 (Natural Disaster/State of Emergency).

According to eMedNY, “[t]here is no need to send additional documentation for Delay Reason 15 at this time. Upon claim review, if the normal claim submission timeframe does not fall within the State of Emergency, documentation may be requested to support the use of Delay Reason 15. All other documentation, such as invoices for pricing that are not related to Delay Reason 15, is still required.

Questions

General questions for claims submission should be directed to GDIT (CSRA) at 1-800-343-9000. Questions on specific claims that are pended for review should be directed to the Bureau of Medical Review, Pended Claims Unit at 1-800-342-3005 (option 3).

If you would like to discuss this with a private attorney, please contact David R. Ross, Esq., Senior Shareholder, via e-mail at dross@oalaw.com or via telephone at (518) 312-0167.