Tag: #claims

Posted in NY Providers, Payer Updates, Updates

EmblemHealth updated timely filling date (claims) for self funded plans!

Posted on by KR2Medical Billing

According to EmblemHealth-for self funded plans: Local 389 Health and Welfare fund- for the DOS 9/1/23 and thereafter have a new timely filling date for submitting claims. The new date is 90 days after the services were rendered.

This new time frame applies to In network and Out of Network providers.

Types of claims: professional, facility and other provider types

Please note that this change DOES NOT APPLY to the other ASOs (Administrative Service Organizations).

The following is still in affect:

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FidelisCare-concurrent prior auth update for family and group therapy services.

This update will apply to any dos of Jan 1, 2026 and thereafter. This update does not apply to SUD services/ providers that are certified as Article 32. 29-I providers are also excluded from the concurrent prior authorization requirenments. Services affected: Family Psychotherapy – CPT Code 90847 Group Psychotherapy – CPT Code 90853    FidelisCare members have 30…

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Healthfirst Pharmacy Update Contrast agent reimbursement

The following information applies to the members in the following plans: Managed Medicaid Plans and Personal Wellness Plans (HARP) Back in 2023, NYS DOH announced that there will be a change to the pharmacy benefits for MMC, HARP members- the pharmacy benefits will be covered but NYRx. This change was finally implemented in April 2025.…

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NYS Medicaid to cover TCM (Therapeutic Transcranial Magnetic Stimulation)

The information discussed below applies to straight NYS Medicaid members for the DOS 10/1/25 and effective for any DOS on or 11/1/25 and thereafter for any Managed Medicaid Members. What is TC? A non-invasive form of brain stimulation using magnetic pulses on specific areas of the brain. This therapy is used to improve the symptoms…

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Posted in Insurance

Announcement: NY Empire Plan Claim Submission for 2019 Services -April 29,2020

Posted on by KR2Medical Billing

General: Please remember that UnitedHealthCare (claim administrator for NY Empire Plan) has a claim submission policy  of 120 days from the DOS (Date of Service). Empire Plan Secondary Claims also have a claim submission policy of 120 days from the date that Medicare or another insurance claim has processed the claim.

For Services performed  at the end of year 2019 have to be submitted on April 29,2020

Paper Claims Address: those providers that are unable to submit electronic claims have to send their claims to The Empire Plan, PO Box 1600, Kingston, NY 12402-1600

Reminder: When benefits are denied because of the claim being submitted late, the participating physician or health care professional MAY NOT BILL the patient for the charges on that claim.

Posted in In The Know Series, Insurance, Training, Updates

NY State Empire Plan-Announcement-claim submission time frames deadline-2020

Posted on by KR2Medical Billing

*Please do not forget that UnitedHealthCare is the administrator for this plan and processes the claims for its members.*

Therefore the providers need to adhere to the following timely claim filing frames:

+No later than 120 days from the end of the calendar year in which the services were rendered (initial claim submission)

OR

+Within 120 days after Medicare or another insurance plan process the claim (secondary claims), whichever is later.

+Empire Claims (for 2019 services) need to be submitted to UHC for processing by April 29,2020

IMPORTANT!

If the claim is denied due to late submission, the participating provider or health care professional may NOT bill the patient for the charges on that claim!