Delayed Medicaid Claim Filing

EMedNY has notified Medicaid providers that during the state of emergency (or until the issuance of guidance by the Department of Health (DOH)), claims submitted that exceed the timely filing limits may be submitted electronically using Delay Reason 15 (Natural Disaster/State of Emergency). Providers do not need to submit documentation substantiating delays related to reason code 15 at this time but may be required to provide such documentation upon claim review if the normal submission timeframe for the claim was not within the state of emergency. The notice, which includes contact phone numbers for provider questions, is copied below.

Contact: Darius Kirstein, dkirstein@leadingageny.org

Delay Reason Code 15 (Natural Disaster) Guidance

During the State of Emergency or until the issuance of subsequent guidance by the NYSDOH prior to the expiration of such state disaster emergency declaration, claims that would normally have been required to be submitted during the State of Emergency exceeding the timely filing limits may be submitted electronically using Delay Reason 15 (Natural Disaster/State of Emergency). Additional documentation for Delay Reason 15 does not need to be sent at this time. Upon claim review, if the normal claim submission timeframe does not fall within the State of Emergency, documentation may be requested to support the use of Delay Reason 15. All other documentation, such as invoices for pricing that are not related to Delay Reason 15, is still required.

General questions for claims submission should be directed to GDIT (CSRA) at 1-800-343-9000. Questions on specific claims that are pended for review should be directed to the Bureau of Medical Review, Pended Claims Unit at 1-800-342-3005 (option 3).