Posted in Insurance, Updates

New York Providers: Empire non-covered services for Managed Medicaid Care

NOTE: This announcement was published in Empire NY Providers communication section on FEB 1,2020

According to Empire BCBS Health Plus (NY)- starting back in 12/1/2019- they began denying claims that were billed with non-covered codes (NY Medicaid).

HCPCS and CPT codes that are not on the NY Medicaid fee schedule are considered non-covered.

This policy affects only MMC and Child Health Plus programs.

Empire suggests that some of these non covered codes should be billed with a more appropriate code or a code that is considered (bundled).

For the list of COVERED codes please click on https://www.emedny.org.

For a complete list of NON covered CPT/HCPCS codes please visit: https://mediproviders.empireblue.com/ProviderUpdates/NYNY_CAID_PU_NoncoveredCPTHCPCSCodes.pdf

Providers should bill the most current CPT or HCPCS code on the current NY Fee Schedule to avoid unnecessary denials.

If you have questions about this announcement please contact your Provider Relations Representative or the Provider Services: 1-800-450-8753

Author:

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s