Health Plans, Providers, and Professionals

The Bureau of MLTC has distributed final implementation versions of the Model MLTC Initial Adverse Determination Notice with Appeals Attachment (ver. 04/15) and the 4687 MLTC Action Taken Notice with Fair Hearing Attachment (ver. 04/15). Below are links to the video and slides for the training webinar conducted on April 29, 2015.

The Recipient Restriction Exception (RRE) Codes are used to identify an individual in active outreach or in receipt of a Medicaid service or program.

The Recipient Restriction Program (RRP) is when an individual's utilization of Medicaid services is considered excessive, following a NYS claims review, the A/R is restricted to only primary providers. The individual is given the opportunity to select which physician, clinic, pharmacy, etc., s/he wishes to use.

Under the brief explanation add three links: and link them to the charts provided.