State Enforcing 90-Day Medicaid Claiming Limit

Although the requirement to file Medicaid claims within 90 days of service is not a new one, e-MedNY has begun enforcing it in a stricter way since late April.  Exception codes that may have worked previously may no longer be accepted.  E-MedNY has posted a set of FAQs on delayed billing on their website.  Additional information on billing claims that are older than 90 days is available here.  According to the materials, exception codes may be used only when a billing delay was caused by circumstances beyond the provider's control.  A governmental entity delay in determining Medicaid eligibility is considered beyond a provider's control.  

If this change is creating a hardship for your organization, please let us know. 

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