Starting 04/01/2021 the following codes will be added to NY Medicaid list of codes that require an authorization.
This change applies to the following UnitedHealthcare Community Plan members:
Starting 05/01/2021– The prescriptions will no longer be covered and paid under the Managed Medicaid Plans (ei. MVP). Instead the prescriptions will be covered under NY Medicaid Fee for Service Fee Schedule.
Where can I find the list of covered medications?
Do I have to participate in NY Medicaid Fee for Service?
As a pharmacy (provider) you will need to participate in NY Medicaid Fee for Service, in order to fulfill the Managed Medicaid Patient RXs.
What else do I need, in order to process claims?
A Managed Medicaid Member has to show you their NY Medicaid Card or your Health Plan Card. As a Participating Pharmacy Provider you will need the CIN number in order to file your claims.
For General Information and Updates please click here.
I recently was contacted by an independent physician (POS 11), regarding an adjustment that states “Medicaid ATB Reduction Applied”. This was on his claims for the Managed Medicaid Plans. Please see below.
Back in early 2020, I warned NY providers that there will be NY State Medicaid reductions (due to COVID-19 Pandemic). My clients already knew to expect it. However, since this particular independent physician had an out-of-state billing services, he was not notified.
So, what does this mean?
ABT stands for across the board. So, the “Medicaid ATB Reduction Applied” means just that- the reduction in payment was applied.
Now it is helpful to mention that this particular independent physician does have an office and a fee for service contract with Managed Medicaid Plans. Not all services are subject to Medicaid ABT Reduction.
Please see below for the partial list of services that are exempt from this reduction:
Some of the services that are subject to this reductions are: (partial list)
Please note that initially NY Medicaid did institute a 1% reduction, effective DOS 01/01/2020 and beyond. However, as of 04/01/2020 that amount is now 1.5%. .
For more information about this and the complete lists of exempt/affected services, please click here to visit the NY Medicaid Website.
KR2 Medical Billing 