Important Update for New York Medicaid Providers: Enrollment Requirement to Avoid Claim Denials
Ensure Compliance to Continue Receiving Payments Without Interruptions
Under the 21st Century Cures Act, all healthcare providers participating in Medicaid Managed Care (MMC) and Children’s Health Insurance Program (CHIP) networks in New York must be enrolled with the state’s Medicaid programs. This mandate is critical to avoid disruptions in claim processing.
Enrollment Details: To prevent claim denials, providers must verify their current enrollment status or complete their enrollment with the New York Medicaid. This process is essential as Managed Care Organizations, including UnitedHealthcare, are required to deny claims from providers who are not registered.
Steps to Enroll or Verify Status: Providers can check their enrollment status or begin the enrollment process by accessing the New York State Department of Health’s provider portal. Detailed steps and links for enrollment are provided on the website to facilitate easy compliance.
Impact of Non-Compliance: During the COVID-19 Public Health Emergency, there was leniency allowed for claims processing for providers who were not enrolled but had retroactively completed their enrollment. As of April 1, 2024, this leniency has ceased, and claims from non-enrolled providers will be outright denied.
How to Handle Claim Denials: In cases where claims have been denied due to enrollment issues, providers have the option to submit a payment reconsideration request. It is imperative that the enrollment dates be prior to the date of service on the claim to qualify for reconsideration.
Support and Assistance: For further assistance, providers can utilize the UnitedHealthcare Provider Portal to access support resources, including chat and direct links to enrollment pages.
Staying compliant with the state’s enrollment requirements is paramount to ensuring that your claims are processed without delay. Check your enrollment status today to avoid unnecessary claim denials and ensure continuous payment for services rendered.
