August 30, 2024
Here’s the Notice from OMH re: use of the Medicaid FFS Delay Reason Code we told you about last night. I firmly believe this instruction applies to OASAS providers as well but will get a confirmation today, if possible.
———- Forwarded message ———
From: omh.sm.medicaidffsbillinghelp <medicaidffsbillinghelp@omh.ny.gov>
Date: Fri, Aug 30, 2024 at 10:26 AM
Subject: Update 8/30/24 – 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: August 30, 2024
SUBJECT: Medicaid Fee-for-Service Timely Filing Denials for Medicaid Primary and Crossover Claims Due to Delays Caused by the Change Healthcare Service Outage – Update to June 7, 2024 Memo
Dear OMH Provider,
On June 7, 2024, OMH sent a memo instructing providers they could use Delay Reason Code 15 (DRC 15), Natural Disaster Delay, when submitting crossover claims to Medicaid FFS that were affected by the Change Healthcare cybersecurity incident (see attached).
OMH is extending the deadline for the use of Delay Reason 15 to be submitted to eMedNY by September 30, 2024, to be considered for payment. As a reminder, claims that are payable using Delay Reason 15 are all claims that couldn’t be submitted timely due to the Change Healthcare/Optum cybersecurity incident only. Submitting claims that do not meet this purpose with Delay Reason 15 is not permitted and may be considered Medicaid fraud subject to review by the Office of the Medicaid Inspector General.
Claims for this incident submitted after September 30, 2024, with Delay Reason 15 will be denied. Please note: if your agency has already submitted (or is in the process of submitting) TCNs to OMH for claims with DRC7, OMH will submit those claims to DOH for reprocessing, you do not need to do anything else. This change is intended to help providers get all affected claims paid as easily as possible, not to add additional work.
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