Uniform Billing Rate Codes for Home Care and Managed Care
On Jan. 4th, the Department of Health (DOH) issued a “Dear Providers and Plans Letter” to inform Medicaid managed care plans and providers that uniform billing codes will be required by May 1, 2017 for Medicaid-covered home and community based long term care services. Included in the letter are the numerous codes and modifiers that will be required for home care (Attachment A) and for Adult Day Health Care (Attachment B). Please note that the modifiers include a description of the services.
The second part of the letter reminds plans and providers that the Public Health Law has been amended to require electronic payments of claims under contract agreements or agreements between long term care providers and plans.
DOH is requiring the full implementation of these codes by May 1, 2017, and has requested status updates on March 1st and April 3, 2017, via email. Please send any questions about the codes to nfrates@health.ny.gov.
LeadingAge NY worked with plans and other stakeholders for years to compile a list of codes with descriptions. Developing the codes and amending the PHL was a critical objective of the Home and Community-Based Care workgroup that LeadingAge NY participated in. Over the last year, numerous surveys we conducted resulted in a consensus that was fair to the majority of plans and providers. Up until last week, we continued to work with DOH on many iterations of the letter to plans and providers.
Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871