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Medicaid to Require EOB Submission with Claims

The Office of the Medicaid Inspector General (OMIG) is developing a new initiative aimed at ensuring that Medicaid is the payer of last resort. Currently, providers must ensure that other payment options such as Medicare or third-party insurance are unavailable prior to billing Medicaid. OMIG announced that in the coming months, providers will be required to attach an Explanation of Benefits (EOB) when submitting Medicaid claims for services rendered to a recipient who is also eligible for Medicare or has other third-party coverage. If an EOB is not submitted with the claim, the claim will be denied. We are seeking more information on the timing and parameters of the new requirement and will keep members informed.

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