LeadingAge NY Urges State to Take Reasonable Approach to Third Party Liability Requirements

Last week, LeadingAge NY sent a letter to the State Medicaid Director urging the State to take a reasonable approach to requirements that Medicaid providers document that they maximize third party reimbursement. Recent articles in the New York State Medicaid Update as well as communications from eMedNY have suggested that the State will be requiring providers to obtain documentation that third party coverage was rejected prior to filing a Medicaid claim for an individual with third party coverage. One of the articles indicated that Medicaid providers will be required to attach an Explanation of Benefits (EOB) to fee-for-service (FFS) claims in order to receive payment from Medicaid for services rendered to a recipient who is also eligible for Medicare or has other third party coverage. The same article indicated that the Office of the Medicaid Inspector General (OMIG) would be providing additional information regarding this requirement.

We had previously expressed concerns to the Department of Health (DOH) about the potential payment delays that such a requirement would cause. The letter formalizes our argument, identifies existing requirements to seek third party reimbursement, and discusses the cash flow implications. We will keep members informed of any developments. The letter is available here.

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