Assembly Bill A6842

2023-2024 Legislative Session

Relates to preclaim review for participating providers of medical assistance program services and items

download bill text pdf

Sponsored By

Current Bill Status - In Assembly Committee

  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

Do you support this bill?

Please enter your contact information

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.
Actions

2023-A6842 (ACTIVE) - Details

See Senate Version of this Bill:
S4439
Current Committee:
Assembly Health
Law Section:
Social Services Law
Laws Affected:
Amd §363-e, Soc Serv L

2023-A6842 (ACTIVE) - Summary

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.

2023-A6842 (ACTIVE) - Bill Text download pdf 

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6842
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                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:
 
   Section  1.  Section  363-e  of  the  social services law, as added by
 section 64 of part H of chapter 59 of the  laws  of  2011,  the  opening
 paragraph  as  amended by section 20 of part C of chapter 60 of the laws
 of 2014, is amended to read as follows:
   § 363-e.  Preclaim  review  for  participating  providers  of  medical
 assistance  program services and items. The department of health and the
 office of the Medicaid inspector general shall jointly develop  require-
 ments  for  preclaim  review.  Every  service  or item within a claim or
 encounter submitted by a participating provider shall  be  reviewed  and
 verified  by  a verification organization prior to submission of a claim
 or encounter to the department of health or to a managed  care  provider
 as  defined in paragraph (b) of subdivision one of section three hundred
 sixty-four-j of this title. The verification organization shall  declare
 each  service or item to be verified or unverified WITHIN THIRTY DAYS OF
 RECEIVING ALL REQUIRED SUPPORTING  DOCUMENTATION  FROM  A  PARTICIPATING
 PROVIDER. Each participating provider shall receive and maintain reports
 from the verification organization which shall contain data on:
   1. verified services or items, including whether a service appeared on
 a conflict or exception report before verification and how that conflict
 or exception was resolved; and
   2.  services  or  items that were not verified, including conflict and
 exception report data for these services.
   § 2. This act shall take effect on the thirtieth day  after  it  shall
 have become a law.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09970-01-3

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.