Page 53

UPDATED: JUNE 2011

495.8

OTHER ELIGIBILITY REQUIREMENTS RETROACTIVE PERIOD

PAYMENT OF UNPAID MEDICAL BILLS

FHPlus: For FHPlus eligible individuals, there is no mechanism to provide coverage in WMS prior to plan enrollment. Therefore, payments to providers for agency error and delay cannot be processed through eMedNY. When the LDSS has determined that it is appropriate to pay expenses, a Medicaid paper claim form that lists the proper Medicaid rates, codes and billing information must be completed by the provider and submitted to the district. Such claims are paid either by the district or the Department, consistent with the choice made by the district.

NOTE: Billing statements from enrolled providers are not acceptable for payment of claims. Providers/districts must submit actual billing forms ordinarily submitted to eMedNY for processing.

(MRG)

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Page 53

Official source

UPDATED: JUNE 2011

495.8

OTHER ELIGIBILITY REQUIREMENTS RETROACTIVE PERIOD

PAYMENT OF UNPAID MEDICAL BILLS

FHPlus: For FHPlus eligible individuals, there is no mechanism to provide coverage in WMS prior to plan enrollment. Therefore, payments to providers for agency error and delay cannot be processed through eMedNY. When the LDSS has determined that it is appropriate to pay expenses, a Medicaid paper claim form that lists the proper Medicaid rates, codes and billing information must be completed by the provider and submitted to the district. Such claims are paid either by the district or the Department, consistent with the choice made by the district.

NOTE: Billing statements from enrolled providers are not acceptable for payment of claims. Providers/districts must submit actual billing forms ordinarily submitted to eMedNY for processing.

(MRG)