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eMedNY Reverses “Three Strikes” Edit

As we reported last week, effective April 25, 2019, eMedNY instituted a new edit for multiple claim submissions for the same service. Edit “02292” (claim submission limit exceeded) was set to deny for all claim types after the second claim resubmission (i.e., if the original submission and two subsequent resubmissions were incorrect).

We are pleased to confirm that eMedNY has reversed this decision and, effective May 1, 2019, has changed edit 02292 from DENY to PAY/REPORT. Claims that fail the edit will be paid and tracked for Department of Health (DOH) informational purposes. HIPAA reason code 273 will still be reported on the 835 remittances so that providers can identify patterns and trends for multiple claim submissions.

Providers that may have encountered denials due to implementation of the edit should resubmit the claim. Questions may be addressed to the eMedNY Provider Services Department at 800-343-9000.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841