September 6, 2022

Calling your attention to the item having to do with OMIG audits (from DoH website)

Office of the Medicaid Inspector General to Issue Audit Reports Related to Third-Party Health Insurance Requirements for Fee-for-Service and Managed Care

The Office of the Medicaid Inspector General (OMIG) will issue draft and final audit reports to providers in the coming months where a response to the initial third-party health insurance (TPHI) review, originally issued by OMIG contractor, Gainwell Technologies, formerly known as Health Management Systems, Inc. (HMS), was not received or payment was not made in-full.

New York State (NYS) Medicaid is the payor of last resort, and all other health care coverage should be exhausted before NYS Medicaid is billed. The initial review required providers to seek reimbursement from Medicare, and all other liable third parties, for services rendered to NYS Medicaid beneficiaries. In accordance with this review and pursuant to Federal Regulation 42 Code of Federal Regulations (CFR) 433, Subpart D as well as NYS regulation, Title 18 of the New York Codes Rules and Regulation (NYCRR), Part 540, §540.6(e) and Part 542, provider cooperation in pursuing these recoveries is required.

Questions

All questions should be directed to OMIG by email at ThirdP@omig.ny.gov or by telephone at (518) 408-5791.

———- Forwarded message ———
From: doh.sm.MedicaidUpdate <000000d00105b3c9-dmarc-request@listserv.health.state.ny.us>
Date: Tue, Sep 6, 2022 at 2:54 PM
Subject: Medicaid Update – August 2022
To: <MUPDATE-L@listserv.health.state.ny.us>

Dear Medicaid Update Recipient,

The Office of Health Insurance Programs of the New York State Department of Health has approved the release of the August 2022 Medicaid Update. Please find the new and improved, interactive issue as a PDF (Portable Document Format) file available to be downloaded at: https://health.ny.gov/health_care/medicaid/program/update/2022/docs/mu_no9_aug22.pdf. A print-ready version is also available on the Medicaid Update web page.

You may also go straight to an article or topic that pertains to you by selecting from the current issue’s table of contents below.

Policy and Billing

• Compound Coverage Clarification (Cover)
• Copayments Waived for Monkeypox Diagnostic Evaluations, Vaccine Administration, and Testing
• Reminder: Pre-Diagnostic Dental Procedure Codes in Dental Clinics Payable Under Ambulatory Patient Groups
• Practitioner Administered Drug Update: New York State Medicaid Fee-for-Service Policy Guidance for SPRAVATO® (Esketamine) Nasal Spray
• New York State Fee-for-Service and Medicaid Managed Care Coverage of Abortion Services
• New York State Medicaid Polio Vaccine Coverage

All Providers

• Office of the Medicaid Inspector General to Issue Audit Reports Related to Third-Party Health Insurance Requirements for Fee-for-Service and Managed Care
• Deleting Facility-Practitioner Affiliations in eMedNY
• Attention: Renew Certification Statements Annually
• Reminder: Sign Up for eMedNY Training Webinars