June 7, 2024
Ongoing NYS Council advocacy has been laser focused on securing the most concrete and helpful response from the state to the claims issues our members are facing as the result of the CHANGE Healthcare clearinghouse cyberattack.
New guidance from DoH, OMH and OASAS just arrived (attached). The Guidance expands on the May 20 OMH Memo (instructing providers to use Delay Reason Code 7 – guidance pasted below).
Today’s guidance eliminates the need for TCN resubmission and is applicable to claims where Medicaid is the primary payor. Specifically, there will be another delay reason code available for this exceptional circumstance (DRC 15) that providers can use through the end of August.
Below please find a link to a version of the notification from the state to Medicaid providers issued by EMedNY. It says ‘all providers’ and I checked with DoH to confirm that (although I haven’t seen an identical Memo to the one OMH sent this morning from OASAS), OASAS Medicaid providers are included.
This latest Guidance may not be a panacea to resolve all of the timely filing issues providers are facing. I don’t think it adequately addresses delays when Medicaid is the secondary payer. I will confer with our billing geeks and then (if needed) continue to advocate for your needs.
- Attached please find the new Guidance dated today, 6/7.
- Below please find the previous OMH guidance (dated 5/20). As you know, we found the first solution to be too narrow to provide relief for the majority of impacted claims.
- Attached is the letter the NYS Council and CHCANYS sent to many state leaders in April, advising of ongoing issues impacting provider financial viability and ultimately, access to care for New Yorkers in need of mental health and addiction services. We have been ramping up the pressure ever since we sent the letter. We are grateful to all state leaders who heard our concerns and responded. there is
Subject: Medicaid FFS Timely Filling Denial Instructions
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