Announcement

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Temporary Waived Timely Filling Requirements for Article 29-I Health Facility Core and Other Limited Health Related Service Claims

February 2, 2024

TO: Article 29-I VFCA Health Facilities (29-Is) and Medicaid Managed Care Plans (MMCPs)
        including Mainstream Managed Care and HIV Special Needs Plans

Due to reports of challenges related to implementation of Article 29-I Health Facility billing requirements, the State will be implementing a one-time, short-term waiver of timely filing requirements for 29-I Health Facility claims. 29-I Health Facility claims that were denied due to untimely filing may be resubmitted. Other claims for dates of service that were not previously submitted during the timely filing window, may also be submitted during this temporary period.

29-I Health Facilities may submit Fee-For-Service (FFS) claims to eMedNY for dates of service on or after February 2, 2022, before March 31, 2024. Claims must be submitted within two years from the date of service.

MMCPs must configure their systems no later than March 1, 2024 to accept 29-I Health Facility claims that are submitted past the timely filing window, but within two years of the date of service. 29-I Health Facilities may submit claims for services provided to MMCP members for dates of service on or after April 1, 2022, between March 1, 2024 and March 31, 2024. MMCPs can begin accepting claims earlier than March 1, 2024, if their systems allow.

MMCPs may submit 29-I Health Facility pass-through claims to eMedNY until April 30, 2024. Claims must be submitted within two years of the date of service.

All claims submitted beyond the 90-day timely filing window must include Delay Reason Code 03. Please note, while use of Delay Reason Code 03 would generally require submission of claims on paper, this requirement does not apply to 29-I Health Facility claims submitted under this guidance.

Both Core Health-Related Services and Other Limited Health-Related Service claims may be submitted under this waiver. This does not apply to 29-I Health Facility claims for Child and Family Treatment and Support Services or Children’s Home and Community-Based Services.

Questions on this one-time allowance can be directed to bh.transition@health.ny.gov.