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Senate Bill S4439

2023-2024 Legislative Session

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

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Archive: Last Bill Status - In Senate Committee Health Committee

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2023-S4439 (ACTIVE) - Details

See Assembly Version of this Bill:
A6842
Current Committee:
Senate Health
Law Section:
Social Services Law
Laws Affected:
Amd §363-e, Soc Serv L

2023-S4439 (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-S4439 (ACTIVE) - Sponsor Memo

2023-S4439 (ACTIVE) - Bill Text download pdf 

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4439
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             February 8, 2023
                                ___________
 
 Introduced by Sen. FERNANDEZ -- read twice and ordered printed, and when
   printed to be committed 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.
                                                            LBD08931-01-3

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