MVP Health Care is offering Child Health Plus (MVP Option Child) in Genesee, Livingston, Monroe and Ontario counties, effective April 1, 2014.
MEDICAID MANAGED CARE AND FAMILY HEALTH PLUS PROGRAMS
Excellus will withdraw their Medicaid Managed Care and Family Health Plus programs from Cayuga, Clinton, Essex, Franklin, Madison, Onondaga and Tompkins counties effective April 1, 2014.
PROVIDER FILE UPDATES
Over the course of the next few months, Excellus will be conducting demographic data verification to ensure provider information on file is current. If your office is contacted by Sutherland Global Services, please provide them with the necessary information.
MEDICAID – PRIMARY CARE RATE INCREASE (PCRI)
The NYS Dept. of Health recently revised the Primary Care Rate Increase. Eligible providers who missed the Aug. 1, 2013, attestation deadline for retroactive qualification may now re-attest and change their qualifying effective date for the PCRI program. To re-attest and change your PCRI effective date, use the PCRI Change/Update Attestation and Qualification form available via the eMedNY website at: www.emedny.org/info/ProviderEnrollment/physician/Option1.aspx.
The effective date must be between Jan. 1, 2013, and Dec. 31, 2014. The form should be submitted as soon as possible so that retroactive payment adjustments can be processed. If the original attestation included nurse practitioners/nurse midwives, you also need to complete and sign the form with an effective date within the supervising physician’s qualification period. If you are unsure of your effective date, check the Physician’s List spreadsheet available via the NYSDOH website at: www.health.ny.gov/health_care/medicaid/fees/.
The Physician List is updated on a regular basis and contains the effective date of each physician, labeled as
“PCRI Begin Date.” Most physicians already have an effective date of Jan. 1, 2013.
If your effective date is Jan. 1, 2013, you do not need to do anything. Physicians who are attesting for the first time must use the Primary Care Rate Increase Attestation form and specify an effective date for your qualification.
As a reminder, the PCRI applies to Evaluation and Management (E/M) and vaccine administration services and applies to Medicaid, Medicaid Managed Care and Family Health Plus members.
The managed care payment schedule has been updated to reflect a delay in PCRI funding for managed care plans. The delay is due to the Department working with CMS to secure federal funding and to set base rates. The Department´s anticipated payment date for Q1-Q3 2013 is May 30, 2014. This delay was unanticipated.
For additional information on PCRI, including access to the most current payment schedule and the provider attestation form, visit www.health.ny.gov/health_care/medicaid/fees/.
For Billing questions, please contact Sarah Howarth at 716-348-3923 or firstname.lastname@example.org<