State Institutes New Medicaid Payment Edit

According to the State’s Medicaid payment contractor, eMedNY, a new edit for multiple claim submissions for the same service was implemented effective April 25, 2019.

According to eMedNY, New York State Social Services regulations (18 NYCRR 540.6) state that any returned claim not correctly resubmitted within 60 days or on the second resubmission is neither valid nor enforceable against the Department of Health (DOH) or a social services district. Based on this regulation, all claim errors will need to be corrected by the third submission (i.e., the original and two subsequent resubmissions) in order to be paid. A new edit, eMedNY edit “02292” (claim submission limit exceeded), is set to deny for all claim types after the second claim resubmission. HIPAA reason code 273 will be reported on the 835 remittances for denials arising from this edit.

For questions or assistance in determining the reason for denial of a claim, Medicaid providers are asked to contact the eMedNY call center at 800-343-9000. Please let us know as well if the new claim edit is causing issues for your organization.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866