Alert to NY Providers: Review of Billing and Claims Denied

The following is from the Advanced Cash Payment Directive slide of NYS Office of Mental Health’s Mental Health Advanced Cash Payment Requirements PowerPoint.
New York State directed several MCOs to resolve outstanding claiming issues with providers by February 24, 2019.
  • By February 24, 2019, MCOs and providers must reach agreement on the total amount of inappropriately denied claims to date and pay that amount to the affected provider.


Cash Advance Requirements if agreement is not achieved within this timeframe:
  • Retroactive Cash Advance – MCOs must offer each affected provider a one-time retroactive cash advance payment for the total amount of denied claims in dispute during the root cause timeframe (excluding duplicate claims submitted).
  • Prospective Cash Advance – MCOs must fix systemic claims payment issues or offer each affected provider a Monthly Prospective Cash Advance equal to the average monthly denied amount (minus duplicate claims) until all payment issues are fixed by the Plan.
  • Additionally, the MCO must resolve any inappropriately denied claims going back to the start of the behavioral health transition and pay any interest owed for failure to comply with prompt pay laws.
  • All cash advanced payments must be reconciled through future claims submissions.
With four years of Parity review for claims denial, expert knowledge of the service model for HCBS, documentation review, and payment adjustments, SAE can provide assistance in this arena. Email to connect with our team.
Keep in mind: the deadline for settling outstanding claims is February 24!