Requires a verification organization to declare each service or item to be verified or unverified within thirty days of receiving all required supporting documentation from a participating provider.
STATE OF NEW YORK
________________________________________________________________________
6842
2023-2024 Regular Sessions
IN ASSEMBLY
May 8, 2023
___________
Introduced by M. of A. KELLES -- read once and referred to the Committee
on Health
AN ACT to amend the social services law, in relation to preclaim review
for participating providers of medical assistance program services and
items
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 363-e of the social services law, as added by
2 section 64 of part H of chapter 59 of the laws of 2011, the opening
3 paragraph as amended by section 20 of part C of chapter 60 of the laws
4 of 2014, is amended to read as follows:
5 § 363-e. Preclaim review for participating providers of medical
6 assistance program services and items. The department of health and the
7 office of the Medicaid inspector general shall jointly develop require-
8 ments for preclaim review. Every service or item within a claim or
9 encounter submitted by a participating provider shall be reviewed and
10 verified by a verification organization prior to submission of a claim
11 or encounter to the department of health or to a managed care provider
12 as defined in paragraph (b) of subdivision one of section three hundred
13 sixty-four-j of this title. The verification organization shall declare
14 each service or item to be verified or unverified within thirty days of
15 receiving all required supporting documentation from a participating
16 provider. Each participating provider shall receive and maintain reports
17 from the verification organization which shall contain data on:
18 1. verified services or items, including whether a service appeared on
19 a conflict or exception report before verification and how that conflict
20 or exception was resolved; and
21 2. services or items that were not verified, including conflict and
22 exception report data for these services.
23 § 2. This act shall take effect on the thirtieth day after it shall
24 have become a law.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD09970-01-3
