2% Across the Board (ATB) Retroactive Adjustment Claim Data Request Form
Based on feedback received from the provider community regarding the 2% Across the Board Retroactive Adjustment reconciliation, the Department has developed a process for sending claim specific data to providers, upon request. The data may be requested, in writing, by completing the 2% Across the Board (ATB) Retroactive Adjustment Claim Data Request Form. In order for the form to be accepted and processed all fields must be completed as instructed and the form needs to be notarized to ensure compliance with the HIPAA Privacy and Security regulations. The Form may be accessed on the main page of the eMedNY website at: www.emedny.org.