May 20, 2024
As the NYS Council Billing Geeks group knows, our association has been pressing state leaders for concrete responses to our letter dated April 24 that describes numerous challenges faced by providers due to the February 2024 CHANGE Healthcare cyberattack.
Last week I shared the information (below) with our billers. I have had just a few responses from billers who saw the information (below) last week and told me that the solutions are vague and too narrow to be very helpful. In addition, they said that this will be a ton of work for your team. I am interested in additional responses from NYS Council member agencies. Please let me know your thoughts: lauri@nyscouncil.org
We meet with our billers on Wednesday mornings from 9:15 – 10:00. If someone in your agency is not already attending these meetings I want to urge you to dedicate a staff person to participate in this very helpful weekly meeting for staff who have difficult jobs. We will discuss the issue of a broad timely filing waiver and the state’s response (below – in part) again this Wednesday. If you need a Zoom link for the meeting, just let Cindy Levernois at cindy@nyscouncil.org know and she will send it to you or your staff person.
———- Forwarded message ———
From: omh.sm.medicaidffsbillinghelp <medicaidffsbillinghelp@omh.ny.gov>
Date: Mon, May 20, 2024 at 11:14 AM
Subject: Medicaid FFS Timely Filling Denial Instructions
To: omh.sm.medicaidffsbillinghelp <medicaidffsbillinghelp@omh.ny.gov>
MEMORANDUM
TO: OMH Providers
FROM: New York State (NYS) Office of Mental Health (OMH)
DATE: May 20, 2024
SUBJECT: Medicaid Fee-for-Service Timely Filing Denials for Crossover Claims Due to Delays Caused by the Change Healthcare Service Outage
____________________________________________________________________________
Dear OMH Provider,
On February 21, 2024, Change Healthcare, a subsidiary of the UnitedHealth Group experienced a cyber-attack causing electronic payments and claims systems to go offline resulting in widespread impacts on providers. Due to this incident, providers are experiencing Medicaid Fee-for-Service (FFS) denials when claims are being submitted for enrollees who have Medicare or Third-Party payers causing delays in receiving the electronic remittance advice (a.k.a. 835 files) from these payers.
Providers should utilize the Delay Reason Code 7 (DRC 7)- Third Party Processing Delay when submitting the crossover claims to Medicaid FFS if applicable[1]. This DRC will allow providers an additional 30 days to submit from the primary EOB. Since many of these claims will already be outside of the 30-day extension, many claims will be denied, even with the DRC 7. To assist providers with these FFS denials for claims billed with DRC 7, providers can supply an Excel spreadsheet listing the Transaction Control Numbers (TCNs) for these denied claims on or before June 17, 2024, to the OMH Medicaid FFS Mailbox: medicaidffsbillinghelp@omh.ny.gov.
When submitting the list of TCNs, providers must include a brief justification explaining what caused the timely filing delay and the actions the agency took to mitigate the issue. The State will then conduct a systematic reprocessing of all submitted TCNs. Please be advised that this will only bypass the timely filing requirement when there is a delay caused by the third-party payer, the claim still needs to meet all other billing rules in order to be paid. In addition, providers may only submit claims for payment that have dates of service under two years.
If you have any questions regarding these instructions, please contact OMH at medicaidffsbillinghelp@omh.ny.gov.
Office of Mental Health
44 Holland Avenue, Albany, New York 12229