SNF Medicaid Provider Required Revalidation

Carl J. Pucci

The federal regulation 42 CFR 455.414 requires providers to revalidate their enrollment with the New York State Medicaid Program. Providers have already received individual written reminders to revalidate, although thousands of providers have not done so. The deadline for submission of revalidation packages was September 25, 2016. We are writing to you because some providers in your association may be affected.

Effective for eMedNY claims processing starting October 27, 2016, all claims from non-revalidating billing providers will be pended until the provider's revalidation package is received. To avoid interruption of claims payment, providers must revalidate immediately.

 To revalidate:

 Visit the Provider Enrollment page at www.emedny.org/revalidation,

locate your enrollment form and additional required documentation, and determine whether an enrollment fee is required. There is a slide presentation, step-by-step processes, and an FAQ section. These resources provide important information on the revalidation process.

  1. Complete and mail the appropriate form(s) with all required documentation to the address provided. Keep a copy of the forms and documentation.
  2. Allow 2 to 3 weeks for the receipt and processing of the revalidation packet by eMedNY. Once your completed revalidation is received and processed, all claims that have been held due to missing or late revalidation will be released for processing during that cycle.
  3. If more than 3 weeks have passed since sending the revalidation to eMedNY, please contact providerenrollment@health.ny.govwith the subject "FINAL REVALIDATION NOTICE" and provide all pertinent information regarding your submission, such as the date you sent it, and the address you sent it to so that we can research it.
  4. The remittance message for these pended claims is: Health Claim Status Code: 46 INTERNAL REVIEW/AUDIT

 If you have additional questions about revalidation, please contact us at providerenrollment@health.ny.govwith the subject "FINAL REVALIDATION NOTICE", or call the eMedNY Call Center at 800-343-9000 Option 2.

Susan Montoya
Bureau of Provider Enrollment
Office of Health Insurance Programs
New York State Department of Health
150 Broadway
Albany, NY  12204-2736
E-mail:  Susan.Montoya@health.ny.gov
Phone:  518-473-6313

NYSHFA CONTACT:

Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36