DOH Processes Second Batch of Appeals
The Department of Health (DOH) has processed a second batch of appeals dating back to 2009 and has posted supporting materials on the Health Commerce System (HCS). Members may recall that DOH processed a first batch of appeals in December 2021. The appeals may result in a positive or negative adjustment. For rate periods through Dec. 31, 2020, payments will be made as lump sums, include both Medicaid fee-for-service and Medicaid managed care volume, and be reflected in Medicaid payment cycle 2324 (check release date of March 23rd). A retroactive rate adjustment for 2021 will be reflected in Medicaid payment cycle 2325 (check release date of March 30th). For negative rate appeals, DOH will start recouping with payment cycle 2325. Providers due a positive payment but who have Medicaid liabilities will have their electronic payment intercepted, and a paper check will be issued after an amount is subtracted to help satisfy the liability.
Providers who may need to file an appeal of this transaction or the December transaction may do so until March 31, 2022. Only appeals filed for appropriate issues and rate years associated with the appeals processed during this payment and appeals processed with the Dec. 2, 2021 Dear Administrator Letter (DAL) will be considered.
Questions regarding these payments should be addressed to NFRATES@health.ny.gov, while questions related to Medicaid accounts receivable, the Electronic Funds Transfers (EFTs), or the amounts withheld can be sent to bimamail@health.ny.gov. Please also let us know if you encounter difficulty accessing the materials or identify discrepancies in your payments.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841