Issue #24-05

The purpose of this Alert is to remind SSHSP providers of timely filing guidelines for Medicaid claims. Per Medicaid Alert #23-09, the SSHSP claiming window is 15 months from the date of service.

SSHSP providers are authorized to use delay reason code 3 for initial submission of claims that are submitted more than 90 days, but no more than 15 months, after the date of service. Providers must accurately and properly utilize delay reason code 3 on claims that are more than 90 days but no more than 15 months old. If an overpayment occurs because claims older than 15 months were paid without prior permission from the Department of Health, or for any other reason, the Medicaid provider must follow the Office of the Medicaid Inspector General (OMIG) self-disclosure process to report, return and explain the identified overpayment. Information regarding self-disclosure can be found on the OMIG "Self-Disclosure" web page at https://omig.ny.gov/provider-resources/self-disclosure.

Requests for extension beyond the 15-month claiming limit must be submitted to the Department of Health by email to SSHSP@health.ny.gov

Questions or comments regarding this alert, may be directed to the OHIP at (518) 473-2160 or SSHSP@health.ny.gov, or the NYS Education Department, Medicaid Unit at medined@nysed.gov.