eMedNY Issues Guidance on Late Claims Related to Change Healthcare Incident

(June 11, 2024) eMedNY has announced that due to the cybersecurity incident that occurred with Change Healthcare/Optum on Feb. 21, 2024, Medicaid claims that exceed established timely filing limits may be submitted electronically using Delay Reason 15 (Natural Disaster). There is no additional documentation required to use Delay Reason 15, although those claims that customarily require documentation (such as invoices for pricing) should be accompanied by all necessary documentation and should be submitted as a paper claim.

The claims that use Delay Reason 15 in this case must be claims that could not be submitted timely due to the Change Healthcare/Optum cybersecurity incident and must be submitted by Aug. 30, 2024 to be considered for payment. Importantly, providers should also maintain documentation supporting the fact that the claims were affected by the incident. (Submitting claims that do not meet this purpose with Delay Reason 15 is not permitted and may be considered Medicaid fraud subject to review by the Office of the Medicaid Inspector General (OMIG).)

General questions for claims submission should be directed to the eMedNY Call Center 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).

Recently updated U.S. Department of Health and Human Services (HHS) Frequently Asked Questions (FAQs) on the incident are available here.

LeadingAge NY has heard from several members whose payments were delayed by the incident who were finding it difficult to obtain duplicate electronic remittances from eMedNY without paying the typical fee. The Department of Health (DOH) was seeking to address the issue. If you are a member who is encountering difficulty getting duplicate Medicaid remittances related to the incident, please let us know.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841