Latest Medicare and Medicaid Provider Program Updates

Healthcare practitioners should be aware of important updates and changes to Medicare and Medicaid Programs of New York and New Jersey. We summarize some of these changes changes below.

Medicaid providers in NY can now check the date their Electronic Transmitter Identification Number (ETIN) expires (decertifies) by using ePACES. According to the Medicaid contractor, providers should be able to see their decertification date by clicking on the “Submitter” under the Support Files section on the left-hand side of the screen and the ETIN and the Decertification date of the ETIN should display. To avoid interruptions in reimbursement providers should recertify by using the appropriate form if the decertification date is is approaching (the link to the form is current at the time of publishing).

New Jersey Medicaid recently announced that fee-for-service Medicaid providers who have yet to re-enroll (revalidate) as part of the Affordable Care Act revalidation requirements will be terminated. New Jersey’s Division of Medical Assistance & Health Services (DMAHS) will begin terminating providers on or after July 1, 2016. The termination will not apply to providers who enrolled or reactived their participation with NJ Medicaid on or after January 1, 2013. Medicaid managed care providers who are also enrolled as a fee-for-service provider prior to the termination date of July 1, 2016 and who want to access recipient eligibility verification information using eMEVS can only do so by submitting to Molina Services Form FD-20C. DMAHS advised managed care providers to submit FD-20C form as soon as possible.

CMS has revised the reassignment of benefits (855R) application. New applications will be available mid-summer 2016. The new form becomes mandatory for providers and other healthcare practitioners beginning on January 1, 2017. The revised and current version of the 855R will continue to be accepted by Medicare Administrative Contractors through December 3, 2016.

If you have questions about Medicare or Medicaid enrollment, revalidation, revocation, re-enrollment or have other health law questions, please contact our office.