September 23, 2022

Note:  OHIP stands for Office of Health Insurance Programs at the State Department of Health (oversees Medicaid managed care, etc.)BCS = Bureau of Consumer Services within OHIP

Good afternoon,

Recently the NYS Council learned that a Council member agency had received a response to a notification they had sent to OHIP BCS stating they wanted to file a complaint against 3 MCOs that were not paying the APG government rates for Article 31 Outpatient Services as required by law.  BCS informed the provider of the list of information it would need from the provider to activate a complaint.  The NYS Council has been fighting to reduce the demand on providers for information when a provider wants to file a complaint.) But in this case, BCS had added new requirements the provider had to comply with in order for BCS to accept the complaint.  Specifically, BCS informed the provider that they would now need to supply proof of in network status with the plans that were the subject of the complaint (a copy of front page and signature page of each contract), AND the provider also had to provide the state information about the specific law, regulation or guidance that the provider believed the plans were violating.

Obviously, this was completely unacceptable to us and we went straight to DoH leads to complain.  I am pleased to report that OHIP/BCS quickly reversed its’ additional  demands for information (discussed above) BUT if your staff have any trouble filing a complaint for any reason, they should call me immediately.  I’m at 518 461-8200 and we can help.
Thanks for sharing this with your billing staff.